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:^ 


ON  THE 

STRUCTURE 

OF  THE 

Central  Nervous  System 

FOR  PHYSICIANS  AND  STUDENTS. ' 


DR.     LUDWia     EDINGER, 

I^'xa.n.lcfoit-ora-ttiÄ-IXEain. 


SECOND   REVISED  EDITION.      WITH    n^    ILLUSTRATIONS. 


TRANSLATED   BY 

WILLIS  HALL  VITTUM,  M.D., 

St.   I=s.xil,  OXEiian. 


EDITED    BY 


C.  EUGENE  RIGGS,  A.M.,  M.D., 

Professor  of  Mental  ai^d  Nekvous   Diseases,   University  of  Minnesota;  Mhmbek  of  the 
American  Neurological  Association. 


PHILADFCM'HIA   AND   LONDON: 

F.    A.    DAVIS,    PUBTJSHER, 
1891. 


Kntered  according  to  Act  of  Congress,  in  the  yeai  VSU,  By 

F.  A.  DAVIS, 

In  the  Office  of  the  Idhraxian  of  Congress,  at  'Washington,  D.  C„  Ü.  8.  A 


Philadelphia,  Pa.,  U.  S.  A.: 

The  Medical  Bulletin  Printing  Honse, 

1231  Filbert  Street. 


AUTHOR'S  PREFACE  TO  FIRST  EDITION. 


The  following  lectures  were  delivered  during  the  winter  of 
1883-4,  before  an  audience  composed  of  practicing  physicians. 
It  was  the  endeavor  of  the  author  to  lay  before  his  hearers  (who 
were  already  familiar  with  the  coarser  anatomy  of  the  brain)  all 
that  had  been  discovered  in  regard  to  its  finer  structure.  It  vvas 
important,  too,  to  present  this,  so  far  as  possible,  as  a  harmo- 
nious whole.  Much  that  was  in  controversy  could  barely  be 
mentioned,  while  here  and  there  only  one  view  of  a  disputed 
question  was  gi^'en, — that  view  which  appeared  most  likely  to 
be  correct,  either  from  the  author's  own  investigations  or  from 
the  writings  of  trustworthy  authors.  This  would  be  absurd  if 
this  work  pretended  to  be  anything  more  than  an  introduction 
into  the  study  of  the  structure  of  the  central  nervous  system. 
He,  however,  who  wishes  to  inform  himself  still  more  accurately 
in  this  direction  will  find  all  that  he  desires  in  the  magnificent 
volume  of  Wernicke,  and  particularly  in  the  superb  works  of 
Meynert  and  Flechsig.  Besides  these,  we  possess  in  Schwalbe 's 
Quain-Hotfmann's  hand-book  a  very  clear  and  comprehensive 
exposition  of  the  anatomy  of  the  brain.  The  student  may  also 
consult  with  great  benefit  the  work  of  Henle,  which  is  based 
mainly  on  his  own  views  and  investigations.  After  searching 
these  authors,  he  will  find  still  further  sources  of  knowledge  in 
the  works  of  B.  Stilling,  KöUiker,  Gudden,  Clarke,  and  others. 

The  author  has  in  his  own  work  (the  results  of  which  can- 
not at  present  be  published  in  extenso)  followed  principally  the 
method  of  investigation  introduced  by  Flechsig,  and  has  thereby 
come  to  entertain  some  views  which  difi'er  from  those  commonly 
accepted.  He  has  ventured,  however,  to  introduce  the  results 
of  his  own  investigations  into  tliis  little  monograph  only  so  far 

(iii) 


IV  AUTHOR  S   PREFACE    TO   FIRST   EDITION. 

as  that  could  be  done  without  the  addition  of  numerous  cuts 
and  prolonged  explanations,  which  the  limits  of  the  work  would 
not  permit. 

Inasmuch  as  it  would  be  impossible  to  give  even  an  incom- 
plete list  of  the  authors  who  have  written  on  this  subject, 
the  writer  has  almost  wholly  ignored  names.  Only  in  the  first 
chapter  has  he  tried  to  mention  those  who  began  the  structure 
at  which  we  are  still  laboring. 

The  author,  in  common  with  all  those  who  have  actually 
worked  in  this  difficult  field,  well  knows  that  very  few  facts 
are  indisputably  settled,  and  that  no  region  of  anatomy  is  more 
subject  to  change  than  the  one  under  consideration.  He, 
therefore,  himself  calls  attention  to  the  fact  that  possibly  here 
and  there  a  line  or  point  may  be  laid  down  a  little  too  confi- 
dently. This,  however,  has  nowhere  been  done  in  the  interests 
of  didactic  clearness  alone. 

The  Author. 

Fkankfort-on-the-Main,  May,  1885. 


f^OOT-NOTE   TO   AuTHOB's   ORIGINAL   PREFACE. 

The  student  who  may  be   anxious  to  keep  himself  posted  on  the 

advances  made  in  the  study  of  cerebral  anatomy  will  do  well  to  consult 

Dr.  Edinger's  annual  reviews  of  the  current  literature  of  the  subject  in 

Schmidt's  Jahrbücher.     These  reviews  have  been  published  regularly 

since  1886. 

The  Editor. 


AUTHOR'S  PREFACE  TO  SECOND  EDITION. 


The  work  on  the  central  nervous  system,  which  now  for 
the*  second  time  appears  before  the  pubhc,  has  undergone  many 
changes  and  been  added  to  in  some  respects. 

Much  that  is  new  has  been  discovered  during  the  last  four 
years.  The  author  lias  endeavored  to  embody  the  most  important 
of  these  discoveries  in  this  book.  The  chapters  on  histology 
and  histogenesis  have  been  entirely  rewritten.  At  some  points 
nothinsr  new  has  been  added,  but  the  old  facts  have  been 
presented  in  a  new  form  (fornix,  cornu  ammonis,  etc.). 

Continued  investigations  have  led  the  author  to  modify  his 
views  in  many  respects.  In  accordance  with  this,  the  sections 
on  the  oculomotor,  the  acoustic,  and  the  fibres  of  the  deep 
marrow  have  been  entirely  rewritten.  The  discoveries  which 
were  published  shortly  before  the  appearance  of  this  book 
concerning  the  course  of  the  tracts  in  the  posterior  roots  per- 
mitted us  to  adopt  a  much  more  simple  plan  of  the  structure  of 
the  spinal  cord  tlian  was  possible  in  the  first  edition. 

The  wish  expressed  on  many  hands  that  this  little  work 
should  be  adapted  to  the  needs  of  those  who  wished  to  practice 
under  its  guidance  has  been  complied  with,  in  that  the  number 
of  cuts  has  been  increased  and  the  description  of  individual 
regions  been  made  mo¥e  exhaustive. 

A  treatise  on  the  comparative  anatomy  of  the  nervous 
system,  based  on  personal  investigation,  has  been  embodied  in 
the  work.  This  addition,  which  permits  us  to  take  a  more 
general  morphological  view  of  the  macroscopic  structures,  will 
also  serve  as  a  guide  to  those  who  wish  to  pursue  independent 
courses  of  study  in  this  most  important  portion  of  brain  anatomy. 

No  comprehensive  description  of  tlie  finer  brain-structure 

(V) 


VI  AUTHOR  S   PREFACE    TO    SECOND    EDITION. 

in  the  lower  animals  can  as  yet  be  given ;  still,  matter  bearing 
on  this  subject  .will  be  found  scattered  here  and  there  throughout 
these  pages. 

Even  now,  when,  by  reason  of  unsatisfactory  methods  of 
investigation,  little  is  known  of  the  brains  of  the  lower  animals, 
still,  enough  has  been  ascertained  to  show  that  a  careful  study 
of  the  conditions  there  prevailing  will  enable  us  to  penetrate 
farther  into  the  finer  structure  than  when  the  mammalian  brain 
was  the  principal  object  of  investigation. 

There  must  be  a  certain  number  of  anatomical  conditions 
which  are  common  to  all  vertebrates — those  which  permit  the 
simplest  expressions  of  the  activity  of  the  central  organ.  It 
only  remains,  to  discover  some  animal  or  some  stage  of  develop- 
ment in  which  this  or  that  mechanism  exists  in  such  a  simple 
form  that  it  can  be  easily  and  clearly  comprehended.  If  we 
have  thus  once  discovered  the  course  of  some  tract  of  fibres  or 
the  arrangement  of  some  group  of  cells,  we  can  ordinarily  recog- 
nize them  in  situations  where  the  picture  is  blurred  by  the 
presence  of  other  structures. 

The  search  after  these  fundamental  lines  in  the  structure 
of  the  brain  is  the  present  task  of  brain  anatomy.  Once  we 
have  accomplished  this,  it  will  be  easy  to  understand  the  com- 
plicated conditions  present  in  the  more  highly  organized  brain. 

Edinger. 

i'EANKt'OET-OW-THB-MAlN,  May.  1889. 


AUTHOR'S  PREFACE  TO  ENGLISH  EDITION. 


Modern  Neurology  owes  so  much  to  the  labors  of  Ameri- 
can physicians  that  the  author  deems  it  a  special  honor  that  his 
book  is  considered  a  fit  guide  for  physicians  across  the  ocean  in 
their  studies  ©f  the  most  difficult  branch  of  anatomy. 

My  best  thanks  are  due  to  the  translators,  Dr.  C.  Eugene 
Riggs  and  Dr.  Vittum,  for  their  efforts  in  bringing  the  author 
into  relation  with  English-speaking  physicians. 

If  this  book,  in  its  new  form,  prove  an  incentive  to  further 

work,  and  if  it  be  productive  of  some  good,  considerable  praise 

is  due  to  the  translators. 

Edinger. 

Frankfokt-on-the-Main,  20  GÄrtnerweg, 
May,  1890. 


(vii) 


EDITOR'S  PREFACE  TO  AMERICAN  EDITION. 


The  great  desire  to  find  for  my  class  in  the  State  University 
an  authoritative  treatise  on  the  structure  of  the  central  nervous 
system  first  suggested  to  me  the  translation  of  Dr.  Edinger's 
work. 

I  feel,  in  presenting  these  twelve  lectures  to  the  English- 
speaking  profession,  that  the  student  and  progressive  practitioner 
are  assured  of  a  reliable  guide  to  a  more  thorough  comprehen- 
sion of  this  most  difficult  and  intricate  subject.  Their  scope 
and  character  are  best  explained  by  the  author  in  his  own 
preface. 

Most  fully  do  I  appreciate  the  cordial  indorsement  given  by 
Dr.  Edinger  to  the  American  edition.  I  Avish,  especially,  to 
extend  to  my  friend,  Dr.  B.  Sachs,  my  sincere  thanks  for  the 
hearty  encouragement  and  the  assistance  without  which  this 
work  would  never  have  been  undertaken ;  and  gladly  do  botli 
Dr.  Vittum  and  myself  acknowledge  his  valuable  aid  in  over- 
looking translation  and  proof  Thanks  are  also  due  to  the 
publisher,  Mr.  F.  A.  Davis,  for  his  untiring  effort  to  render  this 
American  edition  wortliy  of  the  original, 

C.  Eugene  Riggs. 


586  Dayton  Avenue.  St.  Paul, 
Augutit  1,  1800. 


(ix) 


TABLE  OF  CONTENTS. 


LECTUEE  I. 

PAGE 

A  Review  of  the  History  and  Methods  of   Investigating  the 

Central  Nervous  System, 1 

LECTUEE  IL 
Embryology  and  Comparative  Anatomy  of  the  Brain,        .        .       13 

LECTUEE  III. 
The  General  Conformation  and  Histology  of  the  Brain,  .       31 

LECTUEE  IV. 

The  Convolutions  and  Fissures  of  the  Surface  of  the  Cere- 
brum,        45 

LECTUEE  V. 
The  Cortex  of  the  Fore-Brain,  the  White  Substance  of  the 

Hemispheres,  the  Commissures,  and  the  Corona  Radiata,      63 

LECTUEE  VL 
The  Corona  Radiata,  the  Corpus  Striatum,  the  Thalamus,  and 
the  Subthalamic  Region.     The   Structures  at  the  Base 
of  the  Brain .85 

LECTUEE  VII. 

The  Subthalamic  Region,  the  Corpora  Quadrigemina  and  the 

Origin  of  the  Optic   Nerve, 103 

LECTUEE  VIII. 
The  Pons  and  the  Cerebellum, 127 

(xi) 


xll  TABLE    OF    CONTENTS. 

'  LECTUEE  IX. 

PAGE 

The  Roots  of  the  Peripheral  Nerves,  the  Spinal  Ganglia,  and 

THE  Spinal  Cord, 147 

LECTUEE  X. 

The  Spinal  Cord  and  the   Commencement  op  the  Medulla  Ob- 
longata,   173 

LECTUEE  XL 

The  Medulla  Oblongata  and  the  Tegmentum  of  the  Pons,      .     195 

LECTUEE  XII. 

The  Pons — Final  Review, .215 

Index 227 


structure  of  the  Central  Nervous  System. 


LECTURE   I. 


A   REVIEW    OF   THE    HISTORY    AND    METHODS   OF   INVESTIGATING   THE 
CENTRAL    NERVOUS    SYSTEM. 

Gentlemen  :  The  anatomy  of  the  central  nervous  system, 
with  the  main  features  of  which  these  lectures  are  to  make  you 
familiar,  has  engaged  the  serious  attention  of  numerous  investi- 
gators since  the  renaissance  of  anatomical  science. 

Vesalius,  Eustachio,  Aranzio,  Varolio,  and  Fallopia  laid  the 
foundations  upon  whicli  it  was  possible  to  build  in  a  later  age. 
As  early  as  the  seventeenth  century  several  good-sized  mono- 
graphs appeared,  which,  considering  the  methods  of  investigation 
then  pursued,  may  be  regarded  as  exhaustive.  Such  are  the 
books  of  Th.  Willis,  of  Raim,  and  of  Vieussens.  And  yet  at 
this  time  WilUs  could  describe  such  structures  as  the  corpus 
striatum,  the  anterior  commissure,  the  pyramids,  and  the  olivary 
bodies  as  new.  Important  contributions  to  the  anatomy  of  the 
brain  were  made  by  F.  D.  Sylvius,  J.  J.  Wepfer,  and  Van  Leu- 
wenhoeck.  It  was  the  latter,  indeed,  who  first  instituted  micro- 
scopic examination  of  the  brain.  Toward  the  end  of  the  last 
century  v.  Malacarne,  in  Italy;  S.  Th.  von  Sömmering,  in  Ger- 
many; and  Vicq  d'Azyr  and  Rolando,  in  France,  materially 
increased  our  knowledge  of  the  brain. 

At  the  beginning  of  the  present  century  hardly  anything 
of  importance  remained  to  be  added  to  the  description  of  the 
coarser  structure  of  tlic  nervous  system.  Nevertheless,  hardly 
any  advance  had  been  made  in  what  we  to-day  regard  as  tlie 
most  imporbint  part  of  our  knowledge  of  brain  anatomy ;  tliat 
is,  the  minute  connections  of  the  different  parts  of  the  brain 
and  the  course  of  nerve-tracts.  Even  comparative  anatomy,  the 
study  of  which  was  taken  up   during  the  first  part  of  this 

(1) 


!2  LECTURES   ON    THE    CENTRAL   NERVOUS    SYSTEM. 

century,  added  nothing  to  this  knowledge.  Whatever  it  was 
possible  to  discover  by  the  coarse,  macroscopic  methods  of  in- 
vestigation was  discovered  by  Reil,  Gall  and  Spurzheim,  F. 
Arnold,  C.  B.  Reichert,  Foville,  Burdach,  and  others. 

Reil,  in  particular,  who  first  brought  into  general  use  the 
process  of  artificially  hardening  the  brain,  discovered  a  number 
of  anatomical  facts,  which  were  the  result  of  closest  observation. 
As  his  most  important  discoveries  must  be  reckoned  the  arrange- 
ment of  the  corona  radiata,  the  nerve-tracts  of  the  crus  cerebri, 
whose  relation  to  the  fibres  of  the  corpus  callosum,  which  pass 
transversely  through  it,  he  was  the  first  to  recognize.  The 
lemniscus  and  its  origin  in  the  corpora  quadrigemina,  the  len- 
ticular nucleus,  the  island,  and  many  other  parts  were  first 
made  known  through  his  investigations.  As  a  landmark  at  the 
end  of  this  older  period,  we  may  regard  Burdach's  work  on 
"The  Structure  and  Life  of  the  Brain,"  which  appeared  in  1819 
and  contained  all  that  had  been  discovered  up  to  that  time,  be- 
sides adding  much  new  material. 

Up  to  about  the  middle  of  this  century  the  most  prominent 
methods  of  investigation  were  anatomical  dissection  with  the 
knife  and  teasing  out  fibres  from  hardened  specimens  of  brain 
with  forceps.  By  the  latter  method  Gall,  Burdach,  Reil,  F. 
Arnold,  and  Foville  discovered  much  that  was  new.  To  Tiede- 
mann  and  Reichert  is  due  the  chief  credit  of  introducing  the 
study  of  embryology,  from  which  we  have  learned  much  con- 
cerning general  morphological  conditions. 

But  after  Ehrenberg  (1833)  proved  that  "the  organ  of 
mind  "  consisted  of  innumerable  microscopic  "  tubules  ;"  after 
Remak  (1838)  had  given  a  more  accurate  description  of  the 
ganglion-cells,  and  Hannover  (1840)  had  shown  their  connec- 
tion with  the  nerve-fibres,  it  was  plain  that  a  simple  process  of 
teasing  could  never  give  the  desired  insight  into  the  structure 
and  arrangement  of  the  central  nervous  system.  To  B.  Stilling 
is  due  the  great  credit  of  originating  and  bringing  into  use  a 
new  method,  viz.,  the  preparation  of  thin  sections,  or,  rather,  of 


HISTORY    AND    METHODS   OF    INVESTIGATING.  3 

whole  series  of  sections,  which  are  made  in  different  but  in  definite 
directions  through  the  organ  to  be  examined.* 

The  sections  so  prepared  were  carefully  examined  through- 
out, the  pictures  they  presented  combined,  and  thus  the  structure 
and  arrangement  of  the  central  nervous  system  were  determined. 
By  means  of  tliis  method  and  the  studies  which  he  instituted  by 
its  use,  Stilling  laid  the  foundation  of  the  modern  anatomy  of 
the  spinal  cord,  the  oblongata,  the  pons,  and  the  cerebellum. 
On  the  25th  of  January,  1842,  Stilling  froze  a  piece  of  spinal 
cord  at  a  temperature  of  13°  R.,  and  then,  with  a  scalpel,  made 
a  moderately  thin  cross-section.  "When  I  placed  this  under 
tlie  microscope,"  lie  writes,  "and,  with  a  power  of  15  diam., 
saw  the  beautiful  transverse  striations  (central  nerve-tracts),  I 
had  found  a  key  which  would  reveal  the  mysteries  of  the  wonder- 
ful structure  of  the  spinal  cord.  Not  more  joyfully  did  Archi- 
medes cry  out, '  Eureka!'  than  I,  at  the  first  sight  of  these  fibres." 

Stilling's  method  is  the  one  now  most  used  in  investigations 
of  the  central  nervous  system.  It  is  rendered  very  much  easier 
by  the  splendid  hardening  which  these  organs  undergo  in  dilute 
chromic  acid,  or  in  a  solution  of  chromic  salts, — a  discovery  of 
Hannover  and  Eckhardt. 

The  sections  are  made  "  free-hand,"  with  a  razor,  or,  better, 
with  a  microtome,  which  cuts  much  more  exactly  and  enables 
us  to  make  larger  and  more  even  sections.  Welcker,  llivet. 
Weigert,  Thoma,  Gudden,  SchiefFerdecker,  and  others  have 
been  of  service  in  constructing  microtomes  adapted  to  the 
purpose.  We  can  now  divide  an  entire  human  brain  into  an 
unbroken  series  of  sections,  less  than  y^^  millimetre  in  thickness. 

These  sections  may  be  examined  unstained.  All  that 
Stilling  discovered  was  found  in  such  unstained  sections.  It  is 
bettor,  howev(!r,  to  use  staining  fluids. 

To  (ierlacli  is  due  tlie  credit  of  first  calling  attention  (1858) 
to  the  advantages  to  be  derived  from  staining  the  sections  in 

•Thin  K<:ctioiiH  of  tlie  cr^ntral  riervouH  System  lia<l  been  made  liefore  Htillinn's  timo  {«^.g., 
B.  IU)lan(lo,  1824),  but  the  niCoriHtruction  of  the  organ  by  the  combination  of  extended  serieä  of 
■ectionn  wa»  flntt  done  by  Htilling. 


4  LECTURES   ON    THE    CENTRAL    NERVOUS    SYSTEM. 

carmine.  As  time  passed  on,  many  new  staining  methods  were 
devised,  particularly  with  aniline  colors  (nigrosine,  etc.). 

But  it  is  only  very  recently  (1883)  that  we  have  learned 
from  Golgi  a  method  which  brings  out  ganglion-cells  more  dis- 
tinctly than  the  old  one  of  Gerlach.  This  method  rests  on  the 
production  of  a  deposit  of  silver  salts  in  the  cells  and  their 
processes.  The  course  of  the  fibres  in  the  central  nervous 
system  is  not  made  much  more  distinct  by  staining  with  car- 
mine. It  is  possible,  however,  by  a  method  of  staining  with 
hsematoxylin  introduced  by  Weigert  (1884),  to  color  even  the 
finest  nerve-fibril  a  deep  blue-black,  and  so,  making  use  of 
Stilling's  method,  it  is  easy  to  trace  the  course  of  the  fibres 
much  farther  than  was  formerly  possible. 

The  stained  sections  are,  in  accordance  with  the  special 
instructions  of  Clarke  (1851),  dehydrated  by  placing  them  in 
alcohol,  and  then  cleared  up  in  some  ethereal  oil  or  xylol. 
But  unstained  sections  also  reveal  the  course  of  the  fibres  if 
cleared  up  in  xylol,  as  was  done  by  Henle  and  Merkel.  This, 
however,  does  not  always  succeed.  Beautiful  pictures  may  be 
obtained  by  using  the  gold  staining  methods  (Gerlach,  Flechsig, 
Freud,  and  many  others).  Also,  by  staining  the  nerve-fibres 
with  osmic  acid  (Exner). 

Stilling's  method  has  been  followed  by  most  of  the  investi- 
gators of  the  latter  half  of  this  century.  At  the  close  of  each 
lecture  I  will  give  you  the  names  of  those  to  whom  we  are  in- 
debted for  the  most  important  part  of  our  knowledge  of  that 
portion  of  the  brain  which  is  under  consideration  at  the  time. 
But  even  now  you  must  be  made  familiar  with  the  names  of 
two  men.  Stilling  and  Meynert,  to  whom  we  are  under  the 
greatest  obligations,  because  to  them  we  owe  our  knowledge  of 
the  finer  structure  of  the  brain  and  spinal  cord,  and  all  the  later 
investigators  start  out  from  points  which  have  been  settled  by 
them. 

Benedict  Stilling  laid  the  foundations  of  our  knoAvledge  of 
the  anatomy  of  the  pons,  the  cerebellum,  the  medulla  oblongata, 


HISTORY    AND    METHODS   OF   INVESTIGATING.  5 

and  the  spinal  cord,  in  a  series  of  masterly  works,  showing  an 
industry  never  surpassed,  and  which  will  surely  remain  forever  a 
monumenUim  cere  perennitis  of  the  great  physician  of  Cassel. 

Meynert,  however,  not  only  examined  carefully  and  system- 
atically every  region  of  the  brgin  and  spinal  cord,  both  by 
sections  and  by  teasing,  but  by  these  means  he  made  more  new 
discoveries  than  had  been  made  by  any  previous  investigator 
with  the  exception  of  Stilling.  He  not  only  did  these  things, 
but,  with  the  inspiration  of  true  genius,  he  set  up  a  theory  of 
the  structure  of  the  brain,  based  on  its  finer  anatomy,  which 
still  exerts  an  influence  on  the  anatomy  and  psychology  of 
to-day,  and  spurs  us  on  to  further  discoveries. 

It  follows,  from  the  very  nature  of  Stilling's  method,  that  the 
course  of  a  nerve-tract  can  only  be  traced  with  certainty  so  long 
as  the  component  fibres  are  not  interrupted  by  ganglion-cells, 
do  not  pass  out  of  the  plane  of  the  section,  do  not  enter  a 
plexus  of  fibres,  or  split  up  into  innumerable  fibrils  to  be  dis- 
distributed  in  every  direction.  Even  in  the  spinal  cord  of  the 
smallest  animal  it  rarely  occurs  that  a  nerve-fibre  can  be  observed 
running  its  whole  course  in  the  plane  of  one  section.  It  is,  on 
the  contrary,  the  rule  of  the  central  nervous  system  that  the 
nerve-tracts  from  periphery  to  centre  are  broken  up  by  interpo- 
lated ganglion-cells,  and  rendered  difficult  to  follow  by  the 
frequent  interchange  of  fibres. 

Efforts  were  made,  therefore,  particularly  after  we  had 
begun  to  learn  something  in  this  difficult  field  from  the  works 
of  Stilling,  to  devise  further  methods  which  would  enable  us  to 
discover  and  locate  the  nerve-tracts.  It  is  known  that  Waller, 
in  1852,  showed  that  divided  nerves  degenerate  in  definite 
directions.  Before  this  (1850),  Turk  liad  found  that  a  break  in 
tlie  conductivity  of  the  spinal  cord  led  to  degenerations  which 
spread  upward  in  difierent  columns  from  those  affected  by  the 
descending  degenerations.  By  his  labors,  and  those  of  Bou- 
chard, Flechsig,  Charcot,  Monakow,  and  many  others,  it  was 
ascertained  that  perfectly  definite  sets  of  fibres  always  occupy 


6  LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 

the  same  relative  position  in  both  the  brain  and  spinal  cord ; 
that  these  fibres,  when  degenerated,  are  easily  distinguished 
from  the  surrounding  healthy  tissues,  and  so  can  readily  be 
followed  up  along  their  whole  course.  The  study  of  this  sec- 
ondary degeneration  has  been  of  value  in  the  field  in  which  we 
are  now  laboring.     It  promises  still  richer  harvests  in  the  future. 

The  tract  of  fibres  along  which  such  a  degeneration  com- 
monly spreads  is  called  a  system  of  fibres.  A  number  of  dis- 
eases of  the  spinal  cord,  either  at  their  begmning  or  throughout 
their  whole  course,  involve  only  certain  systems  of  fibres ;  for 
instance,  the  posterior  columns  of  the  cord.  Such  diseases  are 
called  systemic  diseases.  The  investigation  of  such  systemic 
diseases  may  also  be  of  service  in  increasing  our  knowledge  of 
the  course  of  fibres  (Flechsig,  Westphal,  Strümpell).  By  the 
accurate  istudy  of  pathological  changes  Charcot  and  his  pupils, 
especially  Pitres,  Fere,  Ballet,  Brissaud,  and  others  have  done 
fruitful  work  in  the  domain  of  brain  anatomy. 

Occasionally  structural  abnormalities  make  it  easier  to 
recognize  one  or  another  of  the  nerve-tracts  than  is  the  case 
in  the  normal  brain.  Thus  Onufrowics  and  Kaufmann  had  the 
opportunity  to  examine  cases  of  defective  corpus  callosum  in 
which,  owing  to  the  absence  of  fibres  of  the  latter,  other  bundles 
of  fibres  appeared  with  a  distinctness  never  before  seen. 

It  was  a  natural  advance  upon  the  study  of  these  degenera- 
tions to  perform  section  of  definite  parts  of  nerve-roots  or  of 
the  spinal  cord,  for  the  purpose  of  studying  the  resulting 
artificial  secondary  degenerations,  and  thus  pressing  farther 
into  the  structure  of  the  organs.  Thus,  for  example,  the  sec- 
tion experiments  of  Schiefferdecker  and  Singer  very  materially 
increased  our  knowledge  of  the  course  of  the  roots  of  the  spinal 
nerves. 

If  either  peripheral  or  central  nerve-substance  is  removed 
from  newborn  animals,  the  fibres  connected  with  the  part  re- 
moved cease  to  develop  and  are  gradually  destroyed,  appar- 
ently because    the   development    of   the    medullary    sheath   is 


HISTORY    AND    METHODS   OF    INVESTIGATING.  1 

stopped.  In  1870  Gudden  made  use  of  this  fact,  and  proposed 
a  new  method  of  investigation,  which  promises  well  for  the 
future.  For  example,  after  the  extirpation  of  an  eye  he  followed 
up  the  resulting  atrophies  in  the  brain  with  sections,  etc.,  and 
found  the  proximal  central  ending  of  the  optic  nerve.  On 
whatever  part  of  the  brain  he  experimented  and  afterward 
examined  by  sections,  he  brought  to  light  new  and  important 
facts.  Besides  Gudden,  we  owe  much  to  Mayser,  Ganser,  Forel, 
Monakow,  and  Löwenthal  for  important  knowledge  gained  by 
this  method  concerning  the  course  of  fibres  in  the  spinal  cord, 
the  method  of  origin  of  different  cranial  nerves,  the  course  of 
the  lemniscus  in  the  brain,  and  much  more  besides. 

Occasionally  cases  present  themselves  where  nature  has 
performed  Gudden's  experiment  on  human  beings ;  thus,  I  was 
once  able  to  examine  the  atrophic  nerve-tracts  caused  by  the 
intra-uterine  amputation  of  an  arm,  and  to  trace  them  higli  up 
into  the  spinal  cord.  At  another  time  I  had  an  opportunity  to 
examine  the  nervous  system  of  a  child  who  had  suffered  an 
extensive  softening  of  the  cortex  of  the  parietal  lobe,  either 
before  or  just  after  birth.  The  crossed  pyramidal  tract  in  tlie 
spinal  cord  was  entirely  wanting.  If  division  of  the  peripheral 
nerves  occur  later  in  life,  as  in  amputations,  the  central  changes 
are  not  so  marked  that  we  can  trace  out  the  course  of  nerve- 
tracts  in  the  spinal  cord  or  brain.  Friedlander  and  Krause, 
however,  have  cleared  up  the  structure  of  the  spinal  nerve-roots 
and  of  the  spinal  ganglia  by  the  study  of  these  "  amputation 
(spinal)  cords." 

Our  knowledge  of  the  course  of  fibres  has  advanced  con- 
siderably by  means  of  the  study  of  secondary  atrophies  and 
degenerations.  Still  greater  advances  have  been  made,  however, 
by  a  method  based  upon  the  study  of  the  development  of  the 
medullary  sheath. 

I*.  Hechsig  deserves  the  credit  of  introducing  this  method 
of  investigation,  which  to-day  appears  to  me  to  be  the  most 
promising  of  all  methods  in  use. 


8 


LECTURES   ON    THE   CENTRAL   NERVOUS    SYSTEM. 


In  a  series  of  communications  (1872-1881)  and  later,  in  a 
larger  work  on  "  The  Course  of  Nerve-tracts  in  the  Brain  and 
Spinal  Cord"  (1876),  he  has  shown  that  the  various  tracts  of 
fibres  which  look  so  much  alike  on  all  sections  of  the  adult 
brain  are  markedly  differentiated  during  the  embryonic  period, 

Ccl4 


^s 


Coa 


The  fibres  of  the  corpus  callosum,  shown  by  tearing  the  hardened  specimen  with  forceps. 

(After  Henle.) 

by  the  fact  that  they  acquire  their  medullary  sheaths  at  different 
times.  Whole  "systems"  in  the  cross-section  of  the  spinal  cord 
are  still  clear  and  transparent  at  a  time  when  others  are  white 
and  contain  medullary  substance.  The  following  up  of  these 
white  portions,  in  both  cross  and  longitudinal  sections,  is  very 
much  easier,  and  gives  very  much  more  certain  results  than 


HISTORY    AND    METHODS    OF    INVESTIGATING. 


tracing  out  a  fasciculus  of  nerve-fibres  in  the  fully-developed 
organ.  In  order  to  give  you  an  idea  of  the  peculiarities  of  the 
methods  just  mentioned,  I  will  first  show  you  a  specimen  which 
was  obtained  by  teasing,  and  which  shows  the  course  of  the  fibres 
making  up  the  corpus  callosum  (Fig.  1).  The  accompanying 
cut  (Fig.  2)  is  made  from  a  frontal  section  through  the  cerebrum 
of  a  9  months'  still-born  fißtus.  In  the  adult  the  whole  field 
shown  here  is  filled  with  fibres,  which,  crossing  and  anastomos- 


FiG.  2. 

Frontal  section  through  the  posterior  portion  of  the  fissure  of  Sylvius  of  the  brain 
of  a  9  months'  still-born  cliilil.  Tho  medullary  fibres  are  shown  black.  In  reality  they 
appear  white  upon  a  gray  back-ground. 

ing  with  each  other,  cannot  be  traced  up.  In  the  case  of  our 
foetus,  however,  of  all  the  various  fibres  of  the  cerebrum,  only 
one  bundle,  the  one  called  the  tegmental  tract,  contains  mcdul- 
hiry  matter.  Nowhere  in  the  cerebi*um,  exce])t  at  tliis  point, 
fan  we  find  medullated  fibres,  Hence,  it  was  easy  for  Flechsig 
to  discover  and  partly  trace  out  the  course  of  the  fasciculus 
tegmf'nti  as  a  distinct  bundle  among  all  the  many  little-known, 
nerve-tracts  of  the  brain. 


10' 


LECTURES   ON    THE   CENTRAL   NERVOUS    SYSTEM. 


The  third  figure  shows  you  a  cross-section  through  the  cer- 
vical region  of  a  spinal  cord  taken  from  a  man  who  lost  his  left 
arm  before  birth.  You  see  that  the  gray  and  white  substances, 
particularly  the  former,  are  markedly  atrophic  on  the  left  side.  A 
more  careful  examination  of  the  extent  of  this  atrophy  gave  a  clue 
to  the  location  of  the  central  termination  of  the  divided  nerves. 
Our  understanding  of  the  general  morphology  of  the  cen- 
tral nervous  system  has  been  advanced  by  nothing  more  than 
by  comparative  anatomy  and  embryology.  Questions  of  great 
importance  have  been  solved  on  the  brains  of  fishes  and  am- 
phibians.    Leuret    and  Gratiolet,   Meynert,   Gottsche,  Fritsch, 

Miclucho-Maclay,  Rabl- Ruck- 
hard,  Rohon,  Wiedersheim, 
Guldberg,  Spitzka,  and  many 
others  have  rendered  service 
in  the  field  of  comparative 
anatomy.  What  we  know  of 
the  embryological  development 
of  the  organs  we  are  now  study- 
ing we  owe  to  Kölliker,  His, 
Tiedemann,  Reichert,  von  Mihal- 
kovics,  Götte,  Dursy,  and  Löwe. 
The  results  of  comparative  anatomy  have  not  been  so  great 
as  might  have  been  expected  so  far  as  marking  out  the  course 
of  nerve-fibres  is  concerned. 

Unlike  the  outer  configuration  of  the  brain,  the  finer  struc- 
ture has  awakened  little  interest ;  although  the  latter  may  be 
said  to  be  the  kernel  of  the  matter,  while  the  former  is  but  the 
outside  shell.  It  may  be  that  this  was  largely  due  to  the  un- 
satisfactory nature  of  the  methods  of  study  available  at  the 
time.  Only  a  few — among  whom  Stieda,  Mayser,  Fritsch, 
Osborn,  Bellonci,  and  Ahlborn  may  be  mentioned  here — suc- 
ceeded in  distinguishing  a  few  tracts  and  marking  out  a  few 
ganglia  and  the  origin  of  a  few  nerves  among  the  complicated 
net-work  of  nerve-fibres  which  is  present  even  in  the  lowest  ver- 
tebrate.    For,  simple  and  easily  understood  as  the  outer  config- 


FiG.  3. 

Section  through  the  cervical  cord  of  a 
man  45  years  old,  who  suffered  an  intra- 
uterine amputation  of  the  left  forearm. 


HISTORY    AND    METHODS   OF   INVESTIGATING.  11 

uration  often  is  in  the  lower  vertebrates,  yet  the  inner  structure, 
particularly  of  those  regions  of  the  brain  lying  caudad  of  the 
optic  lobes,  is  often  not  less  complicated  than  is  the  case  in 
mammals.  The  cells^and  fasciculi  of  fibres  which  are  necessary 
for  the  accomplishment  of  the  simplest  motor,  sensory,  or  psychic 
function  must  everywhere  be  the  same,  and  even  in  the  larvae  of 
the  cyclostomata  they  are  no  longer  perfectly  simple  and  easily 
comprehended.  I  have,  therefore,  endeavored,  in  order  to  come 
nearer  to  a  solution  of  the  questions  before  us,  to  imite  the 
method  of  comparative  anatomy  with  that  of  studying  the  de- 
velopment of  the  medullary  sheath.  We  can  now  stain  and 
trace  out  each  individual  medullary  sheath.  In  fact,  it  was  by 
the  method  of  comparative  embryology  that  we  succeeded  in 
discovering  the  desired  primitive  conditions  in  the  embryos  of 
the  lower  animals,  and  were  able  to  distinguish  a  number  of 
nerve-tracts  which  are  common  to  all  vertebrates. 

You  see,  gentlemen,  the  goal  can  be  reached  in  many  ways. 
In  the  case  of  every  new  question  proposed,  we  must  ask  our- 
selves which  method  is  the  best  to  use,  and,  above  all,  where 
we  may  expect  to  find  the  simplest  conditions.  Seldom  will  an 
examination  of  the  adult  human  organ  attain  the  object  in  view. 
More  often  we  shall  be  compelled  in  some  way  to  bring  about 
by  artificial  means  a  less  complicated  state  of  affairs. 

From  time  to  time  it  has  been  attempted  to  embrace  all 
that  was  known  in  regard  to  the  finer  structure  of  the  central 
nervous  system  in  a  diagrammatic  representation.  The  oldest 
diagrammatic  representation  of  the  fibres  of  tlie  brain  with 
which  I  am  acquainted  is  to  be  found  in  Dos  Cartes'  "  Tracta- 
tus  de  Homine,"  which  appeared  in  1662.  Of  the  newer  works 
belonging  to  this  category  are  the  diagrams  of  the  spinal  cord 
by  Kolliker,  Ludwig,  Bidder  and  Leydig,  and  the  celebrated 
diagram  of  B.  Stilling.  The  plates  of  Mcynert  embrace  a 
larger  field  (from  tlie  spinal  cord  to  the  corpora  quadrigemina), 
and  those  of  Acby,  Flechsig,  and  Jelgersma  (the  whole  central 
nervous  system). 

In    the    Ibllowing    lectures,    gentlemen,    you    will    regard 


12  LECTURES   ON    THE    CENTRAL   NERVOUS   SYSTEM. 

descriptions  and  drawings  as  somewhat  diagramatic.  They 
only  serve  the  purpose  of  bringing  to  your  attention,  in  the  most 
comprehensive  manner  possible,  the  most  important  facts  in 
regard  to  the  course  of  fibres  in  the  central  nervous  system. 
Much  is  still  in  dispute,  but  dimly  marked  out,  with  many 
details  wanting.  Wherever  it  was  practicable  I  have  given  not 
only  those  facts  which  were  discovered  in  a  purely  anatomical 
way,  but  also  those  tracts  which  have  been  determined  by  well- 
observed  pathological  facts.  A  diagram  is  not  always  a  picture 
of  the  demonstrated  course  of  fibres ;  it  is  often  enough  only  a 
graphic  representation  of  the  conclusions  which  have  been  drawn 
from  great  numbers  of  observations. 

A  diagram  is  a  changing  structure.  It  must  be  improved, 
now  here,  now  there.  Certain  parts  often  need  to  be  torn  down 
and  rebuilt.  It  has  been  contended  that  we  ought  not  to  make 
use  of  diagrams  in  a  subject  so  full  of  gaps  as  is  our  knowledge  of 
the  structure  of  the  central  nervous  system.  Let  us  rather  hold, 
with  old  Burdach,  who  wrote  in  1819,  "  The  gathering  together 
material  for  the  building  is  not  all  that  is  necessary.  Every 
time  that  a  new  supply  is  obtained,  we  should  renew  our 
attempts  to  fit  it  into  the  building.  By  thus  giving  it  a  form 
the  spirit  of  investigation  is  not  hampered  in  its  advance ;  on 
the  contrary,  it  is  when  we  first  obtain  a  view  of  the  whole  that 
we  see  the  gaps  in  our  knowledge  and  learn  the  direction  which 
our  investigations  must  take  in  the  future.  May  the  attempts 
at  this  structure  ever  be  renewed.  No  one  who  works  at  it  but 
adds  something  to  our  knowledge." 

[Among  recent  treatises  on  the  anatomy  of  the  nervous 
system  are  the  following : — 

KöUiker,  Handbuch  d.  mikrosk.  Anat.  Leipzig,  1854. — Meynert,  Vom 
Gehirne  der  Saugethiere,  Strieker's  Handb.  d.  Lehre  von  den  Geweben,  1870. — 
Meynert,  Psychiatrie,  I.  Wien,  1884. — Henle,  Handbuch  d.  Anatomie  d.  Nerven- 
systems. Braunschweig,  1879. — Luys,  Recherches  sur  le  Systeme  nerveux  cere- 
brospinal. Paris,  1865. — W.  Krause,  Handbuch  d.  menschl.  Anatomie,  I  Bd. 
Hannover,  1876. — Wernicke,  Lehrb.  d.  Gehirnkrankh,  I.  Cassel,  1881. — Schwalbe, 
Lelirb.  d.  Neurologie.  Erlangen,  1881.  (Contains  most  of  the  literature  up  to 
1881.).— Huguenin,  Allg.  Pathol,  d.  Krankh.'d.  Nervensystems,  I.  Zurich,  1873.— 
Kahler,  Nervensystem  in  Tolds.  GeM'ebelehre,  2  Aufl.,  1888 — Obersteiner,  Anlei- 
tung beim  Studium  des  Baues  der  nerv.  Centvalorg.  Wien,  1888. — Mendel, 
Artikel  "  Gehirn"  in  Eulenburg's  Realencyklopädie,  2  Aufl.     Wien,  1886.] 


LECTURE  II. 

EMBRYOLOGY    AND    COMPARATIVE    ANATOMY   OF   THE    BRAIN. 

Gentlemen:  The  hollow  medullary  t\ibe  of  the  vertebrate 
embryo  presents  at  a  very  early  stage  three  vesicular  enlarge- 
ments at  that  end  which  later  on  develops  into  the  brain.    These 


Com  nttss.  post  ^ 


Vierfiu^fl, 


CerebelUmj 


Fig.  4. 

Longitudinal  section  throngh  the  head  of  an  embryo  ohick  of  4J^  days.  The  five  brain- 
vesicles  are  pretty  clearly  marked.  In  the  roof  of  the  inter-brain  is  a  fold  which  later  on 
becomes  the  pineal  gland.  The  epithelium  of  the  pharynx  is  being  pushed  up  towani 
the  l)ase  of  the  brain,  and  is  the  first  rudiment  of  a  portion  of  the  hypophysis.  (After 
Mihalkovics.) 

Hinttrhimhohle,  Ilind-hrain  cavity.  Nachhirnhöhle,  After-brain  cavity. 

Hi/prjphyHennnlaiie,  Rudiment  of  nypophysi».  Vierhiitiel,  Corpora  (luarlrigomina. 

MitUlhinihöhle  (aqucejucl).  Mid-brain  cavity.  Vnrderhirnhöhh,  Fore-brain  cavity. 

Zwischenhirnhiihh,  Inter-brain  cavity. 

are  the  (primitive)  fore-brain,  mid-brain,  and  hind-brain.  The 
latter  is  soon  divided  into  two  ])arts  by  the  cerebellum  growing 
out  of  the  anterior  portion  of  its  roof.  These  two  divisions 
eventually  become  the  cerebelhuji  and  the  medulla  oblongata 
(afler-brain). 

The  wall  which  closes  the  primary  forc-braiii   in  front  is 
called  the  "embi7onic  terminal  lamina."     From  this  tlicre  are 

(13) 


14 


LECTURES    ON    THE    CENTRAL    NERVOUS   SYSTEM. 


developed  at  an  early  stage,  in  almost  all  vertebrates,  two  smaller 
vesicles, — the-  hemispheres  or  the  secondary  fore-brain.  These, 
which  at  first  are  small,  insignificant  strnctures,  soon  grow  to 
relatively  enormous  proportions  in  mammals,  and,  bending  back- 
ward, cover  most  of  the  other  brain-vesicles.  At  last  they  lie, 
cap-like,  over  the  inter-brain  (thalamus),  the  mid-brain  (corpora 
quadrigemina),  and  the  hind-brain  (cerebellum  and  pons).  Of 
course,  in  spite  of  this  bending  backward  of  the  anterior  vesicle, 
all  the  cavities  (which  are  the  ventricles  of  the  adult  brain)  still 
communicate  with  one  another.  After  the  development  of  the 
secondary  fore-brain,  the  primary  fore-brain  is  called  the  inter- 
brain.  The  roof  of 
this  inter-brain  remains 
throughout  life  as  a 
simple  layer  of  epithe- 
lium. At  the  point  of 
confluence  with  the  fore- 
brain  numerous  blood- 
vessels are  developed 
downward  from  the  cra- 
nial cavity,  which  push 
this  epithelial  layer  on 
before  them.  This  mass 
of  blood-vessels  covered 
with  epithelium,  which  thus  projects  into  the  cavity  of  the  brain, 
is  called  the  choroid  plexus.  Inasmuch  as  the  hemispheres  have 
been  developed  from  the  inter-brain,  their  inner  border  must 
be  continuous  with  this  plexus. 

In  the  frontal  section  of  an  early  human  embryo,  shown  in 
Fig.  6,  this  is  plainly  to  be  seen.  In  this  cut,  too,  you  can  see 
the  cavity  of  the  undivided  primary  fore-brain,  as  the  ventriculus 
medius,  while  the  cavities  of  the  hemispheres  are  marked  as 
ventriculi  laterales.  The  choroid  plexus  sends  processes  into 
the  lateral  ventricles,  which  are  called  the  lateral  choroid 
plexuses.     The  point  where  the  wall  of  the  hemisphere  merges 


Fig.  5. 

Longitudinal  section  through  the  whole  brain  of  a 
newborn  cat.  The  inter-  and  mid-  brains  covered  by  the 
fore-brain.    Magnified  1 : 2. 

Hinterhirn,  Hind-brain.  Mitte.lhirn,  Mid-brain. 

Nachhirn,  After-brain.  Vorderhirn,  Fore-brain. 

Zwinchenhirn,  Inter-brain. 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY    OF    BRAIN. 


15 


into  the  simple  layer  of  epithelii^m  is  called  the  margin  of  the 
hemisphere.  This  margin  is,  at  a  later  period,  clearly  marked 
throughout  its  entire  length  hy  a  bundle  of  white  fibres, — the 
fornix. 

After  the  most  important  portions  of  the  human  cerebrum 
liave  begun  to  develop,  it 
lias  the  appearance  repre- 
sented in  the  accompany- 
ing Fig.  7.  It  has  grown 
out  backward  and  bent 
downward.  At  the  point 
where  the  corpus  striatum 
(wliich  will  be  mentioned 
later)  is  situated  inter- 
nally, the  outer  wall  has 
not  expanded  so  rapidly  as 
in  the  other  regions  of  the 
hemispheres;  so  that  there 
has  developed  or,  rather 
remained  a  depression, — 
the  fissure  or  fossa  of 
Sylvius.  There  can  now 
be  easily  distinguished  an 
anterior  or  frontal  lobe,  a 
posterior  or  occi])ital  lobe, 
and  between  the  two  a 
parietal  lobe. 


Fig.  6. 
Frontal  section  through  the  head  of  a  human  em- 
bryo of'2J^  months.    Shows  the  involution  of  the  fore- 
rpi      ,  .     hrain  vesicle  and  the  rudiment  of  the  corpus  striatum. 

1  iiat     part    observe  the  prolongation  of  the   cortical   layer  into 
.  the  latter,  and  see  how  it  covers  both  the  inner  and 

of    the  hemisphere  which  ««ter  surfaces. 

'■  I'rimUre  Scheidewand,  Primary  <iivis\on-wtxU. 

lies    below  the    fissure  of 

S}lvius  is  called  the  temporal  lobe.  Internally  the  hemispheres 
are  hollow,  and  naturally  their  cavities  conform  to  the  general 
sliape  oi'  the  brain.  That  part  of  the  ventricle  which  lies  in  the 
frontal  lobe  is  called  the  anterior  horn,  that  which  lies  in  the 
occipitid  lobe  the  posterior  horn,  and  that  which  lies  in  the  tem- 
poral lobe  the  inferior  horn.     At  this  stage  of  development  the 


16 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


median  wall  of  the  hemispheres  demands  our  especial  attention. 
That  this  wall  along  its  ventral  border  is  everywhere  continuous 
with  the  epithelium  of  the  choroid  plexus  has  already  been 
shown.  This  condition  is  not  changed  when  it  is  carried  down- 
ward along  with  the  curving  temporal  lobe.  From  the  base  of 
the  embryonic  terminal  lamina  to  the  tip  of  the  temporal  lobe 
this  border  passes  in  a  curve,  marking  the  location  of  the  fornix. 
In  the  anterior  portion  of  the  brain,  somewhat  dorsad  of  the 
fornix,  the  fibres  of  the  corpus  callosum  are  developed,  evidently 
from  a  portion  of  the  embryonic  lamina  terminalis.  They  pass 
across  from  one  hemisphere  to  the  other  in  a  line  which  forms  an 
acute  angle  with  the  fornix.     The  substance  between  the  two. 


SleOe  wo  Vorderhim 
mi  Imischenhirii 
easammenstaisen.. 


Fig.  8. 


Fig.  7. 

Fig.  7. — Brain  of  a  human  embryo  of  the  fourth  month. 

Fig.  8. — Inner  aspect  of  the  embryonic  hemisphere,  shown  in  Fig.  7.  Shows  the  inner 
lower  border  of  the  liemisphere,  which  becomes  thickened  into  the  white  medullary 
line  of  the  fornix.    The  latter,  however,  only  becomes  medullary  after  birth. 

Stelle  wo  Vorderhim  und  Zwischenhirn  zusammenslossen.  Point  where  the  fore-brain  and  mid-brain  meet. 

which,  of  course,  consists  of  the  two  thin  layers  of  the  primary 
division-wall  between  the  hemispheres,  is  the  septum  pellucidum. 
These  are  important  points,  which  I  beg  you  to  study  carefully 
in  the  accompanying  figures. 

In  the  section  shown  in  Fig.  9  you  will  observe  an  ana- 
tomical structure  not  before  mentioned.  On  the  floor  of  tlie 
cerebrum  lies  a  thickening  of  the  same,  which  projects,  free,  into 
the  ventricle, — the  corpus  striatum.  That  layer  of  the  brain- 
wall  which  later,  as  cortex,  gives  rise  to  the  fibres  of  the  cere- 
brum, has  already  begun  to  appear.  You  see  that  an  analogous 
layer  is  present  in  the  corpus  striatum.  In  fact,  in  the  adult 
animal  nerve-fibres  originate  there  just  as  in  the  cortex. 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY    OF    BRAIN. 


17 


Many  fibres  which  originate  in  the  cerebrum  and  pass  into 
the  more  deeply  situated  portions  of  the  nervous  system  must, 


Fio.  9. 

Frontal  section  throufjh  the  corpus  striatum  of  a  human  emhryo  of  Iß  weeks.  Be- 
tween the  rudimeiils  of  tlie  nucleus  caiidatus  and  those  of  the  nucleus  leiitifoiuiis  caa 
be  seen  the  internal  capsule,  in  which  al.so  fibres  can  be  seen  iiassiiig  from  the  wall  of  the 
bemispbere.    Notice  the  arranKcnient  of  the  cells  and  the  course  of  the  fibres. 

neminphUrr.nuxind,  Wall  of  bemisphere. 

in  order  to  reach  their  destination,  pass  directly  through  the 
corpus  striatum.  This  structure  is,  therefore,  divided  into  two 
portions,  an   inner  and   outer,  by  tlio  mass  of  passing  fibres. 


18  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

The  outer  portion  is  called  the  nucleus  lentiformis,  and  the  inner 
the  nucleus  caudatus.  The  mass  of  fibres  between  them  has 
received  the  name  of  internal  capsule.  This  division  of  the 
corpus  striatum  is  plainly  to  be  seen  in  an  embryo  of  four 
months,  but  its  connection  with  the  cortex  of  the  hemisphere 
has  already  disappeared,  and  the  nucleus  lentiformis  and  nucleus 
caudatus  appear  as  independent  gray  bodies.     (See  Fig.  9.) 

The  corpus  striatum  lies  along  the  whole  floor  of  the 
hemispheres.  At  its  caudal  end,  however,  it  is  very  narrow, 
and  only  the  inner  portion  is  demonstrable  at  all  points.  This 
appears  in  all  the  cross-sections  of  the  cerebrum  as  the  tail  of 
the  nucleus  caudatus.  The  outer  portion,  the  nucleus  lenti- 
formis, is  much  shorter.  As  you  see,  the  nucleus  caudatus  pro- 
jects free  and  clear  into  the  ventricle.  The  nucleus  lentiformis 
also  does  at  first.  In  later  embryonic  life,  however,  the  narrow 
fissure  between  it  and  the  hemisphere-wall  becomes  so  small  that 
it  is  no  longer  demonstrable.  But  we  can  always,  even  in  adult 
life,  separate  the  hemisphere- walls  from  the  outer  surface  of  the 
nucleus  lentiformis  without  tearing  any  fibres.  In  the  adult 
'brain  the  situation  of  the  former  fissure  is  of  importance,  for 
here  cerebral  haemorrhages  easily  occur,  and  the  mass  of  efiused 
blood,  if  it  be  not  too  great,  fills  up  the  space  between  the 
hemisphere- wall  and  the  outer  division  of  the  lenticular  nucleus. 

The  peripheral  nerves  appear  very  early.  According  to 
the  extremely  important  discoveries  of  His,  there  are  two  methods 
of  origin  for  the  two  kinds  of  fibres.  All  motor  fibres  arise  as 
axis-cylinder  processes  from  cells  situated  in  the  ventral  portion 
of  the  medullary  tube.  Each  cell  sends  out  a  fibre  which  passes 
to  the  surface,  and  there  unites  with  neighboring  fibrils,  to  form 
a  ventral  nerve-root.  The  sensory  fibres,  which,  as  a  rule, 
emanate  from  the  dorsal  region,  have  an  entirely  different  origin. 
They  arise  not  in  the  central  organ,  but  outside  of  it,  in  the 
ganglia  which  lie  opposite  it  along  its  whole  course.  The  cells 
of  these  ganglia  (spinal  ganglia  and  ganglia  of  the  cranial 
nerves)  send  out  fibres  in  two  opposite  directions.     One  of  these 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY    OF    BRAIN. 


19 


fibres  passes  to  the  central  organ ;  the  other  grows  toward  the 
peripliery  as  a  sensory  nerve. 

The  ganglia'  wliich  are  called  upon  to  play  so  important 
a  part  in  tlie  peripheral  nervous  system  first  appear  in  the  form 
of  a  groove,  the  sides  of  which,  later,  close  so  as  to  form  a  ridge 
(ganglionic  ridge).  This  ridge  lies  on  both  sides  of  the  central 
organ,  and  at  a  very  early  period  becomes  separated  into  the 
mdividual  ganglia.  From  it,  opposite  the  secondary  fore-brain, 
is  developed  the  olfactory  fossa ; 
opposite  the  inter-,  mid-,  and  hind- 
brams,  the  complex  of  the  trigem- 
inus ganglia ;  opposite  tlie  after- 
bran  we  see  the  ganglia  of  the 
acustico-facialis,  of  the  glosso- 
pharyngeus  and  of  the  vagus, 
developed  from  this  gangHonic 
ridge.  Tlie  auditory  fossa,  which 
lies  between  tliem,  apparently 
originates  in  this  ridge.  (His, 
oppos.  Beard.)  Further  caudad, 
the  spinal  gangha  replace  the 
above-named  ganglia  of  the  cra- 
nial nerves,  along  the  sides  of  the 
spinal  cord.  The  roots  of  all 
the  above-mentioned  sensory  cra- 
nial nerves  and  of  the  posterior 
roots  of  the  spinal  cord  issue,  therefore,  from  the  ganglia  and 
grow  into  the  central  organ.  In  the  spinal  cord  there  is  a  cor- 
responding dorsal  sensory  root  for  each  ventral  motor  root.  In 
the  brain,  however,  this  is  not  the  case.  The  distribution  of 
the  motor  nucha  does  not  correspond  closely  to  the  divisions  of 
the  complex  of  ganglia.  The  ganglionic  ridge  has  a  greater 
number  of  segments,  and  several  motor  nuclei  are  equivalent  to 
a  single  complex  of  ganglia.  These  are  the  main  points  in  the 
development  of  the  human  brain. 


Fig.  10. 

Transverse  section  tlirouph  the  spinal 
cord  of  a  human  embryo  df  4  weeks. 
Ventrad  we  see  the  anterior  roots  de- 
veloping from  the  cells  of  the  cord. 
Dorsad  (from  an  embryo  of  4^  weeks> 
the  posterior  roots  grow  centrally  from, 
the  cells  of  the  spinal  ganglion.  "(Com- 
bined from  designs  by  His. ) 


20  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

It  is,  however,  of  no  small  interest  to  examine  the  manner 
in  which  the  development  of  the  brain  takes  place  in  animals, 
proceeding  from  the  lowest  to  the  highest  vertebrates.  The 
limits  set  to  these  lectures  will  not  permit  us  to  enter  the  some- 
times very  important  details  of  the  course  of  fibres  and  the  finer 
structure.  You  will,  perhaps,  most  easily  get  an  idea  of  the 
difference  in  arrangement,  and  see  how  now  this  and  now  that 
portion  of  the  brain  is  most  prominently  developed,  if  you  will 
examine  the  figures,  1 1-1 7.  These  figures  represent,  in  a  shghtly 
diagrammatic  form,  sagittal  sections  through  the  brains  of  the 
various  vertebrate  classes.     If  you  will  first   make  yourselves 


Fig.  11. 
Diagram  of  a  sagittal  section  through  the  brain  of  a  vertebrate. 

Hinterh..  Hind-brain.  Prim.  V.  H.,  Primary  fore-brain. 

Mittelhhm,  Mid-brain.  ScJtluss  Platte,  Embryonic  terminal  lamina. 

Nachh.,  After-brain.  Secund.  Vorilerli.,  Secondary  fore-brain. 

ZiD.  Him,  Inter-brain. 

familiar  with  the  general  diagram  of  a  vertebrate  brain  (Fig.  11) 
you  will  easily  understand  the  other  figures.  You  here  see  that 
the  primary  fore-brain  gives  origin  to  the  secondary  fore-brain 
(hemispheres),  by  a  bulging  out  of  the  lateral  portions  of  the 
embryonic  terminal  lamina.  You  see  how  it  protrudes  ventrad 
into  the  infundibulum,  and  how  its  dorsal  wall  (driven  inward 
by  blood-vessels)  forms  the  choroid  plexusy/ 

Farther  back  the  roof  is  elongated  into  two  sacs,  of  which 
the  anterior  is  called  the  cushion  of  the  epiphysis,  and  the  pos- 
terior the  epiphyseal  tube.  We  recognize  next  the  roof  of  the 
mid-brain  (the  corpus  opticum  or  corpora  quadrigemina),  and 
adjoining   this  the  involuted   layer   of  the    cerebellum.     This 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY    OF    BRAIN.  21 

passes  caiulad  in  a  thin  lamella,  the  velum  medulläre  posticum, 
to  the  dorsal  region  of  the  spinal  cord.  The  lateral  portion 
of  the  inter-brain,  the  tlialamus,  is  not  visible  in  the  plane  of 
Fig.  11.  Secondary  fore-brains  developed  from  the  primary 
fore-brain  vesicle  are  not  found  in  all  animals.  In  the  ray  the 
anterior  wall  of  this  vesicle  simply  becomes  enormously  thick- 
ened, until  it  is  a  large  structure  which  also  contains  the  corpus 
striatum  (Fig.  12).  But  in  many  sharks  we  can  see  little  swell- 
ings on  each  side  in  front  of  this  mass,  the  first  rudiments  of  tlie 
hemispheres.  The  fore-brain  of  bony  fishes  contains  a  large  corpus 
striatum,  but  the  dorsal  portion  of  this  vesicle,  the  pallium,  lias 
not  advanced  beyond  the  embryonic  state  of  a  simple  layer  of 


Fig.  12. 
Braiii  of  a  i-ay. 

Verdickte  Schlusujilalle,  Thickened  embryonic  terminal  lamina. 

epithelium.  From  the  fish  up  to  the  human  being,  the  corpus 
striatum  does  not  materially  change  its  position  or  its  relative 
size.  / 

In  the  same  region  we  find  the  same  aggregation  of  gan- 
glion-cells. In  every  case  there  arises  from  these  cells  a  bundle 
of  fibres  which  passes  backward  and  terminates  partly  in  the  inter- 
brain,  and  in  part  passes  farther  back  into  the  oblongata  (basal 
fore-brain  bundle).  TIk;  pallium,  however,  must  pass  through 
many  stages  of  development  before  there  is  evolved  from  the 
simple  epithelial  layer  which  we  have  just  seen  in  fishes  that 
massive  structure  which,  in  human  beings,  we  call  the  hemi- 
sphere. 


22 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


Even  in  the  case  of  the  amphibians,  where  two  large,  flat 
hemispheres,  of  an  oval  shape,  spring  from  the  primary  fore- 
brain  vesicle,  their  wall,  composed  of  an  outer  layer  of  glia  and 
an  inner  granular  layer,  contains  only  few  and  irregularly-dis- 
tributed ganglion-cells.  In  reptiles  we  first  meet  with  a  deposit 
of  pyramidal  cells,  disposed  in  several  layers  and  covering  most 
of  the  surface, — a  true  brain-cortex. 


Fig.  13. 
Sagittal  median  section  through  the  brain  of  a  bony  fish. 

This  is  most  extensively  developed  in  the  median  wall,  and 
there  are  grounds   for   believing  that  this,  the  lowest  cortical 


Fig.  14. 
Amphibian  brain.    Diagram  of  a  sagittal  section. 

Sinterhim,  After-brain.  Mitlelhirn,  Mid-brain.  Nachh.,  After-brain. 

formation,  is  the  representative  of  the  cornu  ammonis  in  mammals 
(origin  of  the  fornix,  etc.).  From  this  point  on,  the  development 
of  the  fore-brain  takes  place  in  two  different  ways.  In  birds  the 
corpus  striatum  attains  a  relative  size  and  complexity  found  in 
no  other  class  of  animals,  while  the  formation  of  cortex  does 
not  much  increase.  In  mammals,  however,  the  pallium,  with 
its  cortical  layer,  becomes  a  large  structure,  which  causes  the 


EMBRYOLOGY    AND    COMPARATIVE    ANATOxMY   OF    BRAIN. 


23 


corpus  striatum  to  disappear  in  its  depths,  and,  growing  back- 
ward, envelops  the  more  posteriorly  situated  inter-  and  mid- 
brains (in  the  human  being  the  cerebeUum  as  well). 


Fig.  15. 
Brain  of  reptile.    Diagram  of  a  sagittal  section. 

The  cortical  layer  which  covers  the  pallium  at  almost  all 
points  must,  on  account  of  its  great  expanse,  lie  in  numerous  folds. 
These  are  absent  only  in  the  lowest  mammals  (lissencephalous 


Fi(i.  16. 

Brain  of  bird.     Diagram  of  a  sagittal  section. 

MitUlliimdach,  Mid-braia  roof. 


mammals).  In  all  otliers  they  are  present  in  more  or  less 
abundance  (gyrencephalous  mammals).  The  arrangement  of 
these  folds,  which  is  constant  for  the  separate  classes  of  animals, 


24 


LECTURES   ON    THE   CENTRAL    NERVOUS    SYSTExM. 


depends  on  two  factors, — the  extent  of  the  cortical  layer  which 
the  particular  class  has  acquired  during  the  process  of  evolu- 
tion, and  the  capacity  of  the  skull. 

This  does  not  always  keep  even  pace  with  the  growth  of 
the  brain,  inasmuch  as  it  depends  on  other  factors.  The  whole 
pallium  of  mammals  not  only  grows  backward,  but  it  curves 
and  swells  downward  as  well  (not  visible  in  figure). 

That  portion  of  the  hemisphere  lying  farthest  forward,  the 
frontal  lobe,  only  comes  into  special  prominence  in  the  higher 
mammals,  particularly  man  (Meynert).  From  this  extensive 
cortical  layer  of  the  mammalian  pallium  arise  a  great  mass  of 


Fig.  17. 
Mammalian  brain.    Diagram  of  a  sagittal  section. 

fibres, — the'  corona  radiata.  These  pass  out  of  the  hemisphere  to 
terminate  in  the  inter-brain,  the  hind-brain,  the  after-brain,  and 
the  spinal  cord.  Other  large  bundles  pass  through  the  hemi- 
spheres, connecting  their  different  regions  with  one  another.  All 
these  taken  together  form  a  great  deposit  of  medullary  matter 
under  the  cortex.  The  extent  of  this  is  relatively  largest  in 
human  beings.  In  lower  mammals  it  is  only  small.  Tn  the 
mouse,  for  example,  it  is  insignificant.  Besides  this,  there  is 
developed  in  the  cortex  of  all  animals  a  thick  net-work  of  medul- 
lary fibres,  which  serves  to  connect  all  parts  with  each  other. 
In  all  vertebrates,  from  the  cyclostomata  up  to  human  beings, 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY    OF    BRAIN.  25 

there  springs  iiom  the  base  of  the  fore-brain,  on  each  side,  a  process 
whose  cavity  at  first  communicates  with  the  cavity  of  the  ven- 
tricles. These  are  the  olfactory  lobes.  They  are  always  cov- 
ered witli  a  cortex  of  peculiar  structure,  from  which  the  non- 
m-edullary  fibres  of  the  olfactory  nerves  arise  in  many  bundles. 
In  the  case  of  only  a  few  animals  (the  cyclostomata,  for  example), 
a  single  olfactory  nerve  springs  from  each  olfactory  lobe,  and, 
passing  to  the  organ  of  smell,  is  divided  into  many  branches. 
In  mammals  the  anterior  portion  of  the  lobes  becomes  separated 
from  the  rest  of  the  brain,  and  is  known  as  the  olfactory  bulb. 
This  is  connected  with  the  lobe  proper  by  a  long,  slender  process 
containing  both  cells  and  fibres, — the  olfactory  tract.  In  many 
mammals,  and  particularly  in  human  being-s,  the  olfactory  lobe 
becomes  atrophic,  and  little  more  is  visible  on  the  under  surface 
of  the  brain  than  the  olfactory  bulb  and  tract. 

The  inter-brain  is  in  all  animals  an  elongated  body,  whose 
lateral  walls  contain,  in  the  case  of  the  lower  vertebrates,  two, 
and  in  higher  several  "  thalamic  ganglia."  The  walls  thickened 
by  these  ganglia  reduce  the  third  ventricle,  which  lies  between 
them,  to  the  dimensions  of  a  narrow  slit.  In  the  bony  fishes 
the  mid-brain  grows  to  such  a  degree  that  it  completely  covers 
up  and  hides  the  inter-brain.  The  base  of  the  inter-brain 
bulges  out  to  form  the  infundibulum,  which  is  a  large  process 
in  the  lower  vertebrates,  and  which  does  not  always  become 
fused  Avitli  the  hypophysis,  which  grows  toward  it  from  the 
pharyngeal  epithelium  through  the  base  of  the  skull.  In  many 
fishes,  particidarly  tlie  selacians,  numerous  blood-vessels  grow 
into  the  infundibulum,  and,  pushing  the  epithelium  before  them, 
form  the  "saccus  vasculosus," — apparently  a  secreting  organ. 
The  roof  of  the  inter-brain  is  formed  anteriorly  of  the  choroid 
plexus.  Farther  back  it  becomes  elongated  into  a  tube,  which 
is  directed  forward, — the  tube  of  the  epiphysis.  In  some  sela- 
cians, and  in  many  reptiles,  this  passes  through  an  opening  in 
the  skull  to  an  organ  of  special  sense,  which  strikingly  resem- 
bles an  eye.     We  can  recognize  a  cornea  and  a  lens,  a  retina 


26  LECTURES    ON    THE   CENTRAL    NERVOUS    SYSTEM. 

and  a  pigmentary  layer  lying  in  and  under  the  latter,  in  this 
'•  parietal  organ."  We  owe  its  discovery  to  Graaf  and  Spencer. 
In  the  other  vertebrates  we  detect  no  relation  between  the  epi- 
physeal tube  and  the  organ  of  special  sense  in  the  adult  animal. 
The  tube  has  disappeared  in  the  depths  of  the  skull,  and  the 
parietal  eye,  as  is  shown  by  transitional  forms  in  amphibians 
and  reptiles,  is  so  completely  lost  that  no  trace  of  it  can  be 
found  in  birds  or  mammals.  The  blunt,  knotted  end  of  the 
tube  remains  as  a  nodule,  the  "  pineal  gland,"  in  front  of  the 
mid-brain.  One  of  the  thalamic  ganglia,  the  ganglion  haben- 
ulse,  demonstrable  in  all  animals,  is  united  with  its  fellow  of  the 
opposite  side  by  a  commissure.  This  commissura  thalami  dorsalis 
forms  a  part  of  the  roof  of  the  inter-brain  in  front  of  the 
epiphysis. 

In  all  animals  the  optic  tract,  lying  on  the  outside  of  the 
inter-brain,  passes  in  a  gradual  descent  from  the  mid-brain  to  the 
base  of  the  brain.  Between  it  and  the  inter-brairi  proper  there 
is  found,  in  fishes,  amphibians,  reptiles,  birds,  and  mammals, 
another  ganglion  which  lies  more  or  less  firmly  imbedded  in  the 
mass  of  the  thalamus  (corpus  geniculatum  laterale).  It  is  one  of 
the  poii^ts  of  origin  of  the  optic  nerve.  The  main  point  of 
origin  of  these  nerves,  however,  is  the  roof  of  the  mid-brain. 
This  roof  changes  less  in  the  different  classes  of  animals  than 
any  other  part  of  the  brain.  Only  its  relative  size  changes,  and 
he  who  has  only  seen  the  small  corpora  quadrigemina  of  the 
human  brain  will  be  astounded  when  he  sees  the  huge  optic 
lobes  of  a  fish  or  a  bird ;  but  the  finer  structure  is  always  the 
same.  From  the  dorsal  layer  of  the  hemispherical  lobe,  which 
is  somewhat  flattened  by  a  sagittal  furrow,  the  optic  nerve 
always  takes  its  origin.  From  the  deeper  layers  arises  a  system 
of  sensory  fibres, — the  deep  marrow.  The  latter  forms  a  net- 
work around  the  aqueduct  of  Sylvius,  and  the  greater  part  of  it 
passes  caudad  as  the  lemniscus,  or  fillet. 

In  the  posterior  part  of  the  mid-brain  roof  there  is  in  all 
animals  a  separate  nucleus,  fibres  from  which  associate  them- 


EMBRYOLOGY    AND    COMPARATIVE    ANATOMY   OF   BRAIN.  27 

selves  with  the  deep  marrow.  This  is  the  corpus  qiiadrigeminum 
posticum.  In  mammals,  in  whom  the  anterior  portion  of  the 
roof  remains  relatively  small,  this  posterior  quadrigeminal  body 
reaches  nearly  the  size  of  the  anterior  one.  In  all  the  figures 
it  is  marked  by  shading. 

Not  only  in  the  bony  fishes,  but  also  in  birds,  the  roof  of 
the  mid-brain  has  undergone  special  development.  The  simple 
hollow  hemisphere  grows  outward  and  downward  on  both  sides, 
so  that  the  lengthened  roof  closes  around  the  lateral  portion. 
Inasmuch  as  this  condition,  peculiar  to  birds,  would  not  be 
visible  in  a  sagittal  section,  the  mid-brain  in  Fig.  16  is  not 
divided,  but  is  left  so  as  to  show  it  as  it  appears  in  the  uncut 
brain. 

The  base  of  the  mid-brain  is  formed  by  masses  of  fibres 
which  come  from  the  fore-  and  inter-  brain  to  pass  farther  back. 
To  these  masses  are  added  the  fibres  springing  from  the  roof  of 
the  mid-brain,  and,  lastly,  there  are  found  in  this  situation  a 
number  of  nuclei  from  which  bundles  of  fibres  arise,  which  in 
part  pass  to  the  cerebellum,  and  in  part  reach  the  surface  of  the 
brain  as  peripheral  nerves  (oculomotor,  trochlear).  One  con- 
dition, which  is  rudimentary  in  birds,  is  more  developed  in 
mammals.  Many  fibres  from  the  cortex  of  the  hemispheres  are 
massed  together  and  lie  ventrad  of  the  fibres  at  the  base  of  the 
mid-brain.  This  mass,  called  the  pes  of  the  crus  cerebri,  or 
crusta,  is  very  strongly  developed  in  primates  and  in  man.  In 
sucli  brains  we  call  all  that  lies  dorsad  of  it  and  beneath  the 
roof  of  the  mid-brain  the  tegmentum.  Fishes,  reptiles,  and 
amphibians  possess  only  the  tegmental  tracts ;  the  fibres  of  the 
<-rusta  are  wanting,  because  in  them  no  fibres  pass  downward 
from  the  cortex.  The  majority  of  the  fasciculi  of  tlie  crusta  and 
tegmentum  pass  on  to  the  base  of  the  cerebellum  and  medulla 
oblongata,  where  many  terminate.  A  part  pass  into  the  roof  of 
the  hind-brain. 

This  roof,  which  is  continuous  in  front  with  the  layer  of 
the  corpora  quadrigemina,  and  behind,  through  the  intervention 


28  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

of  a  thin  membrane  (velum  medulläre  posticum),  passes  into  the 
posterior  part  of  the  spinal  cord,  contains  the  rudiments  of  the 
cerebellum.  If  you  look  at  the  sections  shown  in  Figs.  12  to  17, 
it  will  strike  you  that  with,  perhaps,  the  exception  of  the  fore- 
brain,  no  part  of  the  brain  shows  so  many  changes  in  develop- 
ment as  this.  But  the  cerebellum  is  not,  like  the  cerebrum, 
more  developed  in  the  higher  classes  of  animals  than  in  the 
lower.  We  find  very  remarkable  differences  in  animals  very 
nearly  related  to  each  other,  and,  on  the  other  hand,  in  the  lower 
selacians,  for  instance,  an  extremely  good  development  of  the 
organ.  In  the  amphibians  we  meet  with  the  cerebellum  in  its 
simplest  form.  The  side  of  the  roof  of  the  hind-brain  which 
faces  the  mid-brain  is  thickened  into  the  form  of  a  plate  lying 
across  the  ventricle.  Reptiles  do  not  possess  this  organ  in  a  very 
high  state  of  development,  but  in  those  of  them  that  swim 
(alligators)  this  plate  is  twice  as  thick  as  ordinary,  and  extends  as 
far  backward  as  the  caudal  side  of  the  roof.  Large  swimming 
animals,  the  bony  fishes  and  the  selacians,  possess  a  cerebellar 
organ  which  is  so  enormously  developed  that  it  must  lie  in  huge 
transverse  folds  (Fig.  12),  and  even  at  times  pushes  itself  forward 
under  the  roof  of  the  mid-brain  into  the  aqueduct  of  Sylvius 
(Fig.  13).  Fishes  living  in  mud  (dipnoi)  have  a  smaller  cere- 
bellum. 

In  fishes,  amphibians,  and  reptiles,  bundles  of  fibres  pass 
from  the  inter-  and  mid-  brain  to  the  cerebellum,  and  from  the 
spinal  cord.  We  find  these  same  bundles  in  birds  and  mammals, 
but  in  the  former  there  are  added  very  small,  and  in  the  latter 
very  large,  bundles  of  fibres  from  the  fore-brain.  These  termi- 
nate in  structures  which  we  now  meet  for  the  first  time,  devel- 
oping on  each  side  of  the  middle  portion  of  the  cerebellum  the 
hemispheres  of  the  cerebellum.  In  birds  these  are  still  small, 
but  in  mammals  they  increase  along  with  the  development  of 
the  middle  portion  (from  now  on  called  the  worm,  vermis)  until 
they  far  exceed  the  latter  in  size.  The^vermis,  however,  even 
in  the  human  being,  retains  the  transverse  foldings  which  have 


EMBRYOLOGY    AND    COMPARATIVE   ANATOMY    OF   BRAIN.  29 

characterized  the  cerebelhim  in  all  classes  above  the  selacians. 
Directly  caudad  of  the  cerebellum  in  the  roof  of  the  hind-brain 
we  meet  with  ganglionic  masses,  which  give  off  fibres  to  the 
trigeminal  and  the  acoustic  nerves.  Fused  closely  with  the 
cerebellum  they  are  only  small  nuclei  in  mammals,  but  in  fishes 
they  form  quite  respectable  lobes. 

From  the  thalamic  region  to  the  end  of  the  spinal  cord  the 
central  cavity  (ventricle,  central  canal)  is  surrounded  with  masses 
of  gray  substance,  rich  in  ganglion-cells,  and  caudad  of  the 
mid-brain  w^e  find  in  this  gray  matter  the  peripheral  nerves 
arising  from  their  nuclei.  In  the  gray  substance  of  the  floor 
of  the  hind-  and  after-  brain  arise  a  great  portion  of  the  fibres 
of  the  trigeminal  and  abducens,  a  part  of  the  acoustic  and  of 
the  vago-glosso-pharyngeal.  Somewhat  nearer  the  surface  lies 
a  column  of  nuclear  cells,  from  the  upper  part  of  which  the 
motor  root  of  the  fifth  pair  arises,  and  farther  caudad  the  facial 
nerve.  From  the  hind-brain  to  the  sacral  portion  of  the  spinal 
cord  there  is  an  unbroken  series  of  nuclei.  There  are  really 
two  series,  one  more  ventral  (zone  of  anterior  horn,  His)  and  the 
other  more  lateral  (lateral  zone).  From  the  former  arise  the 
liypoglossal  and  all  the  anterior  roots  of  the  spinal  nerves  going 
to  the  muscles  of  the  trunk.  From  the  latter  there  arise 
(Gaskell)  fibres  which  are  concerned  in  the  innervation  of  the 
muscular  coat  of  the  viscera.  These  lateral  fibres  leave  the 
central  organ  along  with  the  anterior-horn  fibres,  except  in  the 
region  of  the  medulla,  where  they  go  to  form  the  motor  vagus 
and  the  accessory  nerves.  Farther  down  they  leave  the  spinal 
cord  in  company  with  the  other  fibres  of  the  anterior  roots. 
According  to  Gaskell  the  latter  pass  into  the  mixed  nerves, 
while  the  former  are  connected  with  the  sympathetic. 

In  the  ventral  portion  of  the  pons  and  oblongata  there  are 
situated  many  aggregations  of  ganglion-cells  and  nerve-fibres, 
whose  relations,  varying  widely  throughout  the  animal  kingdom, 
cannot  be  discussed  hero.  It  is  of  importance  that  all  the  nerve- 
fibres  which  connect  the  brain  with  the  centres  situated  below 


30  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

pass  through  these  parts.  Through  the  presence  of  all  these 
structures  this  portion  of  the  brain  is  thicker  than  the'  spinal 
cord,  which  comes  next  to  it.  The  latter  forms  a  column  from 
the  segments  of  which  there  arise  anteriorly  the  motor  and 
posteriorly  the  sensory  nerves.  The  space  to  the  outside  of  the 
nuclei  of  the  nerves  is  occupied  by  fibres  which  connect  the 
spinal  cord  with  the  brain,  and  the  different  portions  of  the 
spinal  cord  with  one  another. 

In  the  oblongata  and  spinal  cord  of  certain  animals  we  find  peculiar 
structures,  wliicli  have  resulted  from  hypertrophy  of  some  pre-existing  organ.  I 
will  only  mention,  as  examples,  the  great  hypertrophy  of  the  motor  nucleus  of 
the  trigeminal  in  the  ray, — the  lobus  electricus  ;  the  enormous  nucleus  of  the 
vagus  of  fishes,  projecting  high  into  the  fourth  ventricle,  which,  together  with 
the  trigeminal,  provides  for  the  sensation  of  the  skin  ;  and  the  hypertrophy  of 
the  posterior  horns  of  the  spinal  cord  in  certain  fishes  (Trigla). 


LECTURE  ITT. 

THE   GENERAL   CONFORMATION    AND    HISTOLOGY   OF   THE   BRAIN. 

Gentlemen:  Although  these  lectures  are  not  addressed 
to  beginners,  but  to  those  who  have  a  general  acquaintance 
witli  the  coarser  anatomy  of  the  brain,  it  will  not  be  entirely 
superfluous  to  review  our  knowledge  and  to  form  a  clear  image 
of  brain-structure  in  our  minds.  The  outlines  of  the  map  in 
which,  later,  we  intend  to  mark  out  all  the  points  and  by-ways 
which  are  of  importance,  will  be  definitely  fixed  by  a  recapitida- 
tion  of  what  has  already  been  learned.  Taught  by  embryology, 
you  will  easily  understand  the  morphological  conditions  presented 
by  the  organ  of  the  adult  individual. 

A  fresh  brain  is  laid  oil  its  base.  You  will  easily  discover 
the  great  fissure  which  separates  the  two  hemispheres  and  the 
fissure  of  Sylvius  which  was  originated  by  the  growth  of  the 
temporal  lobe.  Inasmuch  as  the  hemispheres  have  grown  over 
most  of  the  other  portions  of  the  brain  (Fig.  5),  we  could  get  a 
view  of  the  latter  posteriorly  by  raising  up  the  hemisplieres  and 
uncovering  them.  This  could  also  be  accomplished  by  removing 
a  portion  of  the  hemispheres.  The  latter  method  has  the  ad- 
vantage of  giving  us  a  view  of  the  lateral  ventricles  and  the 
corpus  striatum,  and  we  Avill  therefore  follow  it. 

Tlie  linife  lield  horizontally  passes  through  both  hemi- 
spheres at  once  and  removes  layers  from  2  to  3  milHmetres 
in  thickness.  The  first  and  second  of  these  layers  contain  much 
cortical  matter  and  relatively  little  of  the  inclosed  white  sub- 
stance ;  but  in  removing  the  third  layer  we  have  uncovered  a 
large  white  field  of  mocUdlary  matter  in  the  middh;  of  each  hemi- 
sphere, the  centrum  semiovale.  In  it  run  all  those  fibres  which 
pass  from  the  cortex  downward,  and  a  part  of  tliose  fibres  which 
connect  the  different  portions  of  the  cortex  with  one  another. 

(31) 


32 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


On  looking  at  Fig.  6,  we  should  expect  that  on  removing 
another  layer  we  should  find  the  hemispheres  separated  from 
the  ventricle  only  by  a  thin  layer  of  epithelium.  This,  however, 
is  not  the  case.  At  a  later  period  of  embryonic  development, 
thick  masses  of  fibres  have  developed  and  pass  from  one  hemi- 
sphere to  the  other  at  a  point  shown  by  the  letter  a  in  Fig  6. 


Sim 


Ccl 


Fig.  18. 

Fore-brain  from  above.     The  liemispb€*es  have  been  removed  at  the  level  of  the 
corpus  callosum  (Ccl).    The  white  space  between  Ccl  and  the  cortex  is  the  centrum  semi- 
ovale.    Lt,  ligamentum  tectum  or  striae  longitudinales  Lancisi,  a  part  of  the  cortex 
which   borders  on  tlie  corpus   callosum.     8lm,  strise    longitudinales   mediales,   white       , 
bundles  of  fibres  which  interlace  on  the  middle  Of  the  corpus  callosum.     (After  Henle.) 

Thus,  at  the  bottom  of  the  great  fissure  we  do  not  find  the  ven- 
tricle, but  the  corpus  callosum,  as  the  mass  of  transverse  fibres 
is  called. 

The  corpus  callosum  is  now  divided,  and  after  the  white 
substance  which  lies  over  the  ventricles  on  each  side  has  been 
removed  it  is  cut  off  before  and  behind.     Then  it  is  seen  that 


GENERAL    CONFORMATION    AND    HISTOLOGY    OF    BRAIN.  33 

its  under  surface  is  connected  with  some  delicate  masses  of  white 
fibres  wliich,  aichiiio-  over  the  cavity  of  tlie  ventricle,  pass  down- 
ward to  the  floor  of  the  same  before  and  behind.  They  belong 
to  the  fornix.  After  they  and  tlie  adherino-  choroid  plexus  are 
divided  and  removed,  we  find  ourselves  looking  into  the  cavity 


Cerc\>c»>»n>. 


FlO.  19. 

The  brain  oi)ene(l  by  a  liorizontal  setaioir.    \'iewecl  from  ubove.    Th.;  two  hemispheres  are 

drawn  somewhat  apart. 

VtitKrhorn,  Inferior  horn. 

of  the  ventricle.  The  middle  space  is  tlie  cavity  of  the  primary 
fore-brain,  now  called  the  third  ventricle.  From  the  depths  of 
its  anterior  end  ascends  the  margin  ol'  the  secondary  fore-brain, 
the  fornix.  It  is  directly  continuous  with  the  median  wall. 
The  latter  is   traversed   by  the  fibres  of  the   corpus  callosiim. 


34  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

That  part  of  the  median  hemisphere-wall  which  lies  below 
the  corpus  callosum  (it  appears  behind  it  in  the  cut)  is  called 
the  septum  pellucidum.  That  part  of  the  original  fissure  be- 
tween the  hemispheres  which  remains  between  the  right  and 
left  layers  of  the  septum  is  called  the  ventriculus  septi  pel- 
lucidi.  If  you  will  imagine  the  corpus  callosum  removed  from 
Fig.  19,  the  continuation  of  the  hemisphere  wall  into  the  septum 
and  the  significance  of  the  ventriculus  will  at  once  become 
apparent.  It  is  no  real  ventricle,  but  only  that  portion  of  the 
fissure  between  the  hemispheres  which  is  covered  in  by  the 
corpus  callosum. 

On  each  side  of  the  fornix  lies  a  passage  from  the  third 
ventricle  to  the  two  lateral  ventricles, — the  foramen  of  Monro. 
That  part  of  the  lateral  ventricle  which  lies  in  the  frontal  lobe 
is  called  the  anterior  horn,  that  which  lies  in  the  occipital  lobe 
the  posterior  horn,  and  that  lying  in  the  temporal  lobe  the  in- 
ferior horn.  You  can  easily  insert  your  finger  into  each  of  these 
horns.  The  basal  regions  of  both  hemispheres  are  connected 
with  each  other  by  the  anterior  commissure.  You  can  see  its 
bundles  of  white  medullary  fibres  passing  in  front  of  the  pillars 
of  the  fornix. 

The  nucleus  caudatus  emerges  from  the  floor  of  the  lateral 
ventricle.  Farther  back,  however,  parts  come  into  view  which 
no  longer  belong  to  the  hemisphere, — the  thalamus  (inter-brain) 
and  the  corpora  quadrigemina  (mid-brain).  Behind  these  ap- 
pears the  upper  surface  of  the  cerebellum  (roof  of  the  hind- 
brain). 

Along  the  whole  inner  border  of  the  hemispheres  runs  the 
thick  mass  of  white  fibres  constituting  the  fornix.  It  arises 
from  the  boundaries  between  the  hemispheres  and  the  mid-brain 
on  either  side  from  the  floor  of  the  ventricle,  and  passes  over  the 
optic  thalamus  into  the  apex  of  the  temporal  lobe. 

In  removing  the  corpus  callosum  we  removed  also  the 
middle  portion  of  this  arch  of  the  fornix ;  so  that  we  only  see, 
anteriorly,  close  to  the  septum  Dellucidum,  the  ascending  portion 


GENERAL    CONFORMATION    AND    HISTOLOGY    OF    BRAIN. 


35 


of  the  arch  (crura  fornicis),  and,  posteriorly,  the  descending 
portion, — a  white  Une  of  medullary  jnatter,  which,  passing  along 
the  border  of  the  hemisphere,  bounds  the  temporal  lobe  on  its 
inner  aspect.  If  you  connect  the  points  i^./and  F.II,  in  Fig.  19, 
with  a  gentle  curve  which  passes  over  the  optic  thalamus,  you* 
will  have  restored  the  course  of  the  fornix^     In  the  accompany- 

.ing  median  section  of  an  embryonic  brain  you  can  easily  dis- 
tinguish the  course  of  the  fornix.  In  our  dissection  (Fig.  19) 
you  can  see  the  thalamus  behind  the  nucleus  caudatus.  It 
belongs  to  the  inter-brain,  and  has  developed  from  its  lateral 
walls.  The  space  between  the 
two  thalami  is  the  cavity  of  the 
former  inter-brain  vesicle.  Of 
its  roof  only  a  thin  layer  re- 
mains, the  most  important  part 

.  of  which  is  the  pineal  gland. 
Fig.  4  sliows  how  this  arose  by 
a  process  of  protrusion.  All 
the  rest  of  the  roof  of  the  former 
vesicle  is  only  present  in  the 
form  of  a  thin  epithelium,  be- 
longing to  a  plexus  of  vessels 
which  cover  the  middle  ventricle. 
The  floor  of  the  inter-brain, 
which  is,  of  course,  formed  an- 
teriorly of  the  embryonic  terminal  lamina,  consists  of  a  mass  of 
gray  matter,  which  is  prolonged  in  a  funnel-shaped  manner 
toward  the  base  of  the  skull.  This  projection  is  called  the  tuber 
cinereum,  and  its  cavity  the  infundibulum.  It  is  not  shown  in 
Fig.  19,  but  can  be  clearly  seen  in  tlie  median  section  (Fig.  17). 
At  its  extreme  end  tlie  tuber  cinereum  is  fused  into  the  fold 
of  pharyngeal  mucous  membrane  which  grows  toward  it,  as 
shown  in  Fig.  4.  At  a  later  stage  the  latter  is  cut  off  from  the 
pharynx  and  n^mains  in  the  cavity  of  the  skull,  wlierc,  in  con- 
nection with  the  tuber  cinereum,  it  forms  the  liypophysis, — an 


SftSt  wo  Xorderhim 
und  Ziüisdienhim 


Fig.  20. 


Inner  aspect  of  the  embryonic  hemi. 
sphere,  shown  in  Fig.  7.  Shows  the  inner 
lower  border  of  tlie  liemispbere,  which  be- 
comes thickened  into  the  white  medullary 
line  of  the  fornix.  The  latter,  however,  only 
becomes  medullary  after  birth. 

Stelle  wo  Vorderhirn  und  ZwUchenhim  zusam- 
mensloaiien.  Point  where  the  fore-brain  and  mid-brain 
meet. 


36  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

irregular,  roundish,  ball-shaped  body,  the  size  of  a  cherry,  which 
is  attached  to  the  base  of*  the  inter-brain  by  a  slender  pedicle. 

The  thalamus  is  slightly  separated  from  the  nucleus  cau- 
datus  by  a  bundle  of  fibres,  called  the  stria  terminalis.  On  tlie 
anterior  portion  of  its  surface  the  anterior  tubercle  is  usually 
seen  as  a  rounded  swelling.  It  corresponds  to  a  separate  gan- 
glion within.  Still  another  ganglion  belonging  to  the  thalamus 
will  be  found  if  we  follow  up  the  white  line  which  runs  along 
the  median  ridge  of  the  thalamus  (stria  medullaris).  This  gan- 
glion is  a  small,  club-shaped  mass  lying  far  back,  just  in  front  of 
the  corpora  quadrigemina,  and  is  called  the  ganglion  habenulse. 
From  this  there  arises  on  each  side  a  thin,  white  bundle  of  fibres 
which  passes  to  the  pineal  gland, — the  pedunculus  conarii.  The 
gray  mass  of  the  thalamus  is  overlaid  with  white  fibres  (stratum 
zonale),  which,  in  part,  pass  to  the  optic  nerve.  A  principal 
point  of  origin  for  this  nerve  is  a  protuberance  on  the  posterior 
part  of  the  thalamus, — the  pulvinar.  Macroscopic  observation 
alone  would  place  the  source  of  the  optic  nerve  in  this  ganglion 
and  in  two  nodules  on  its  under  side  (corpus  geniculatum  mediale 
and  laterale).  Between  the  thalami  there  extends  a  thin,  gray 
lamina, — the  middle  commissure.  I  have  never  failed  to  find  it 
if  the  brain  was  carefully  taken  out. 

The  nerve-tracts  from  the  hemispheres  which  lie  deep  down 
between  them  and  the  thalamus  emerge,  for  the  most  part, 
caudad  of  the  thalamus  from  the  main  mass  of  the  cerebrum. 
They  form  thick  strands,  and  lie  exposed  on  the  ventral  surface 
of  the  mid-brain, — the  corpora  quadrigemina ;  taken  together, 
they  are  called  the  crura  of  the  brain  (pedunculi  cerebri). 

Behind  the  pineal  gland  begins  the  roof  of  the  mid-brain. 
We  regard  the  posterior  commissure  as  the  most  anterior  por- 
tion of  this  roof,  as,  arising  in  the  thalamus,  it  passes  caudad 
through  the  mid-brain.  The  corpora  quadrigemina,  which  ap- 
pear just  behind  this  commissure,  we  shall  examine  later  on. 

If  the  brain  is  opened  from  above,  as  we  have  done,  only 
the  inner  portion  of  the  corpus  striatum — the  nucleus  caudatus — 


GENERAL    CONFORMATION    AND    HISTOLOGY    OF    BRAIN. 


37 


can  be  seen.  The  outer  portion — the  lenticular  nucleus — lies 
deeper,  and  is  covered  with  medullary  masses,  which  pass  over 
it  into  the  internal  capsule.  We  could  expose  it  by  opening 
downward  outside  of  the  nucleus  caudatus,  but  you  will  get  a 
better  idea  of  its  form  if  a  frontal  section  is  made  transversely 
through  the  whole  brain  at  the  point  in  Fig.  19  where  the  thala- 


Frontal  section  tlirough  the  adult  brain.     Explanation  in  the  text. 
Ballan,  CorpuB  ciill>>8iim.  Marklmjer,  While  siibstanc«. 

mus  begins,  just  behind  the  thickest  part  (caput)  of  the  nucleus 
caudatus  ;  that  is  to  say,  just  behind  the  ascending  pillars  of  the 
fornix. 

It  is  not  difficult  to  understand  the  cross-section  (Fig.  21) 
if  we  keep  in  mind  tlio  conditions  shown  in  Fig.  6.  The  brain- 
wall  is  decidedly  thicker  than  at  the  fcctjil  pfMJofl.  but  the  corpus 


38  LECTURES   ON    THE   CENTRAL   NERVOUS    SYSTEM. 

striatum  rises  from  the  floor  just  as  shown  in  that  section.  The 
outer  fissure  has  now  disappeared,  but  it  may  be  considered  as 
occupying  the  situation  shown  by  the  dotted  hne  on  the  right 
side.  « 

At  the  bottom  of  the  great  fissure  you  can  see  the  ventricle 
covered  by  the  thick  cross-fibres  of  the  corpus  callosum.  To 
these  there  pass  from  below  the  two  pillars  of  the  fornix, 
leaving  the  ventriculus  septi  pellucidi  free  between  the  thin 
layers  of  the  septum  pellucidum.  They  project  freely  into  a 
cavity,  the  lateral  ventricle.  This  cavity  is  bounded  exteriorly 
by  the  corpus  striatum.  Just  here  you  can  see  beautifully  how 
the  corpus  striatum  is  penetrated  by  and  apparently  divided 
into  two  ganglia  by  the  thick  masses  of  fibres  of  the  internal 
capsule.  In  the  lenticular  nucleus,  that  is,  in  the  outer  portion 
of  the  corpus  striatum,  you  can  easily  distinguish  three  divisions. 
Only  one  of  these  three  parts — the  external,  shown  most  deeply 
shaded,  called  the  putamen — may  be  regarded  as  a  source  of 
origin  of  fibres,  together  with  the  nucleus  caudatus.  The 
function  of  the  two  internal  divisions  (globus  pallidus)  is  still 
uncertain.  The  globus  pallidus  sometimes  consists  of  three  or 
more  divisions.  External  to  the  lenticular  nucleus  there  lies  a 
thin,  gray  mass  in  the  wall  of  the  hemisphere, — the  claustrum. 
The  space  between  it  and  the  lenticular  nucleus  is  called  the 
external  capsule.  Farther  out  still  lies  the  cortex  of  the  island 
of  Reil.  The  gray  mass  on  the  floor  of  the  middle  ventricle 
belongs  to  the  wall  of  the  infimdibulum, — the  tuber  cinereum. 
It  and  its  continuation  are  called  the  central  (ventricular)  gray 
substance.  At  the  point  where  this  and  the  cortex  of  the  tem- 
poral lobe  become  continuous  there  lies  a  large,  roundish  nucleus, 
— the  nucleus  amygdalae.  It  probably  stands  in  some  relation  to 
the  origin  of  the  olfactory  nerve.  In  its  finer  structure  it  re- 
sembles the  claustrum  (Mendinol).  Between  the  pillars  of  the 
fornix  you  see  the  anterior  commissure.  Its  fibres  curve  back- 
ward as  they  pass  through  the  corpus  striatum.  For  this  reason 
we  again  meet  them  on  cross-sections  of  the  brain,  just  below 


GENERAL   CONFORMATION    AND    HISTOLOGY    OF    BRAIN.  39 

the  outer  part  of  the  lenticular  nucleus  (Fig.  21,  l)elow  and  to 
the  right). 

I  cannot  urge  you  too  strongly,  gentlemen,  to  look  up  in 
the  fresh  brain  all  the  parts  mentioned  in  to-day's  lecture,  and 
learn  the  situation  of  each  by  your  own  dissection.  The  repre- 
sentation by  word  and  picture  may  give  you  a  good  idea  of 
them,  but  it  can  never  take  the  place  of  that  which  may  be 
obtained  by  study  of  the  fresh  specimen. 

The  difference  in  colors  which  you  have  observed  to-day  in 
the  fresh  brain  specimens  is  caused  by  differences  in  their  finer 
structure.  To  this,  the  histology  of  the  central  nervous  system, 
we  will  now,  for  a  short  time,  turn  our 
attention. 

The  brain  is  made  up  of  nerve- 
tissue  and  a  matrix.  This  matrix  is 
composed  of  the  walls  of  numerous 
blood-vessels  which  pass  in  every  direc- 
tion through  the  organ,  and  of  the 
neuroglia,  most  delicate  cells,  with  a 
net-work  of  fine  ciliary  processes,  which,  fig.  22. 

V  •  •    i  •       1     1         -iU     it-  c  Isolated  neuroglia  cells. 

becommg  nitermmgled  with    those   01 

neighboring  cells,  are  matted  together  into  a  sort  of  dense  felt. 
This  structure  may  well  be  likened  to  a  mass  of  burrs  stuck 
together  witli  a  few  thicker  strands,  the  blood-vessels,  passing 
among  them.  The  nerve-fibres  are  imbedded  in  the  free  spaces 
between  the  cells  of  the  neuroglia. 

The  net-work  of  neuroglia  is  somewhat  differently  con- 
stituted in  different  parts  of  the  central  nervous  system,  and 
forms  here  and  there  thick  masses,  altogether  free  from  nerve- 
substance. 

Thus,  for  instance,  a  broad  zone  of  almost  immixed  neu- 
roglia is  spread  over  the  whole  surface  of  the  brain  and  spinal 
cord.  The  larger  ganglion-cells  are  often  so  entangled  in  neu- 
roglia that  they  seem  to  be  lying  in  a  fine-meshed  basket. 


40 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


The  nerve-substance  proper  which  fills  out  the  spaces  m  the 
above-described  net-work  consists  of  ganglion-cells  and  nerve- 
fibres. 

The  form  of  the  ganglion-cells  is  extremely  varied.  Round- 
ish, almost  spherical  bodies  of  small  size  are  seen,  together  with 
multipolar  cells  with  many  processes,  and  twenty  times  the  size 
of  the  smaller  cells. 


Fig.  23. 

From  a  piece  of  spinal  cord.    A  and  ß,  ganglion-cells ;  at  D,  axis-cylinder ;  p,  protoplasmic 

process ;  c,  neuroglia-cells.     (After  Ran  vier.) 

In  the  lobus  nervi  vagi  of  the  torpedo  and  in  the  medulla 
oblongata  of  the  river  lamprey  are  found  such  enormous  ganglion- 
cells  that  they  can  readily  be  seen  with  the  naked  eye.  In  the 
spinal  cord  of  the  electric  eel,  the  malaterus,  are  two  isolated 
ganglion-cells  of  such  a  size  that  the  huge  single  nerve-fibre 
which  each  gives  off  is  sufficient  to  supply  the  very  large  elec- 
tric organ  of  the  animal. 


GENERAL    CONFORMATION    AND    HISTOLOGY    OF    BRAIN. 


41 


The  nerve-fibres  arise  from  the  ganglion-cells.  R.  Wagner 
first  showed  that  but  a  single  process  of  these  cells  could  be 
traced  directly  into  the  nerve,  and  other  investigators  have  con- 
firmed this.  The  relations  which  the  other  processes  of  a  multi- 
polar cell  and  the  processes  of  the  cells  which  do  not  possess  this 
'•axis-cylinder"  process  have  to  the  nerve-fibres  remained  in 
darkness  until  Gerlach,  in  1870,  showed  that  these  processes 
form  a  net-work  with  each  other,  and  that  from  this  net-work 
nerves  arise.  It  is  only 
during  the  course  of  the 
past  year  that  Bellen ci  first, 
and  later,  in  a  still  more 
convincing  manner,  Golgi 
and  Bela  Haller  succeeded 
in  showing  the  method  of 
origin  of  nerve-fibres  from 
th(*  central  ganglionic  cells. 
Golgi  conducted  his  investi- 
gations on  the  cortex  of 
human  beings  and  of  other 
animals,  and,  by  frequent 
combinations  of  very  com- 
plicated microscopical  pic- 
tures, arrived  at  the  same 
conchisions  with  Haller, 
who  worked  on  mollusks, 
where  the  conditions  were 
more  simple,  and  the  relations  could  be  plainly  seen.  The  most 
important  of  these  discoveries,  which,  moreover,  have  been  con- 
firmed for  otlier  parts  of  the  central  nervous  system  by  Golgi's 
])upils,  is  the  now  well-established  fact  tliat  tlie  nerve-fibres  arise 
from  the  cells  of  tlie  central  nervous  system  in  two  ways;  that 
there  is  a  direct  and  an  indirect  origin  of  nerves. 

The  former  we  have  already  montion(>d  as  liaving  been  dis- 
<;ov(rc(l  by  Wagner.     The  axis-cylinder  process  of  a  ganglion-cell 


Fig.  24. 

From  a  section  through  the  pleiiro-cerebral 
ganglion  of  the  flssurella.  1,  net-work  of  nerves; 
2,  ganglion-oells  ;  3,  nervi'-fihies.     (After  Henle.) 


42  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

passes  directly  into  a  nerve-fibre.  Recent  investigations  have 
shown  that  before  passing  off  it  gives  rise  to  minute  fibrils, 
which  form  a  fine  net-work.  This  direct  form  of  nerve-origin 
has  been  recognized  in  the  great  pyramidal  cells  of  the  cortex, 
and  in  the  cells  of  Purkinje  in  the  cerebellum,  in  the  nuclei  of 
the  motor  nerves  in  the  brain  and  spinal  cord,  and  in  othgr  places. 

In  many  other  cells,  however, ''tte  processes,  soon  after 
leaving  the  cells,  break  up  to  form  a  fine  net-work,  which  re- 
ceives, also,  the  lateral  fibrils  of  the  axis-cylinder  processes 
before  mentioned,  and  from  this  net-work  the  nerve  takes  its 
origin.  This  net-work  may  contain  the  off'shoots  of  a  great 
number  of  ganglion-cells.  In  the  accompanying  section  through 
the  pleural  ganglion  of  a  snail  you  may  see  both  methods  of 
nerve-origin  taking  place  side  by  side  (Fig.  24). 

What  part  is  played  by  the  cell  processes  which  do  not 
become  connected  with  the  nervous  system — Golgi  calls  them 
protoplasmic  processes — is  not  yet  determined.  There  is  ground 
for  believing  that  they  are  connected  with  the  fine  net-work 
composed  partly  of  glia  and  partly  of  connective  tissue,  w^hich 
surrounds  the  blood-  and  lymph-  vessels  of  the  central  nervous 
system ;  that  is,  that  they  bear  some  relation  to  the  nutrition  of 
the  cells  themselves.  The  fact  that  this  fine  net-work,  which 
consists  of  all  these  processes  of  ganglion-  and  glia-  cells,  is  so 
difficult  to  disentangle  has  naturally  led  to  other  views  as  to  its 
composition  than  the  one  I  have  given  you,  but  it  is  important 
to  notice  that  all  the  later  authors,  whatever  their  differences  of 
opinion  in  regard  to  the  net-work  (Leydig,  Nassen),  have  ob- 
served the  double  method  of  origin  of  nerve-fibres. 

It  is  probable  that  the  difference  in  origin  denotes  a  differ- 
ence in  function.  We  know  that  the  motor  roots  of  a  peripheral 
nerve  arise  directly  from  the  axis-cylinder  of  the  cells,  and  it 
was  in  the  sensory  posterior  roots  that  Gerlach  observed  the 
breaking  up  of  the  nerves  into  this  minute  net-work.  The  in- 
vestigations of  His,  to  which  I  referred  in  the  last  lecture,  bear 
out  the  views  we  have  adopted. 


GENERAL    CONFORMATION    AND    HISTOLOGY    OF    BRAIN. 


43 


The  nerve-fibres  in  the  brain  and  spinal  cord  are  of  varying 
size  in  adult  mammals,  and  all  are  probably  surrounded  with 
medullary  sheaths. 

Every  nerve-fibre,  as  it  enters  tlie  central  organ,  loses  its 
sheath  of  Schwann.  Only  a  thin  layer,  first  seen  by  Ranvier, 
and  which  is  present  even  in  peripheral  nerves,  is  left  to  cover 
the  nerve-marrow  after  it  enters  the  brain  or  spinal  cord. 

In  general,  the  parts  which  consist  only  of  medullary  fibres 
appear  white  (white  substance);  those  composed  mainly  of 
A  B  /J  3?  E 


Tzt 


ecu 


Fig.  25. 
Different  nerve-flbres  isolated  from  the  spinal  cord  of  a  dog.    ca,  axis-cylinder ;  -mg, 
medullary  sheath  ;  <■/,  peripheral  membrane  ;  c,  nucleus  and  protoplasm  to  be  seen  on  the 
surface  o"f  a  few  fibres.     (After  llanvier.) 

neuroglia,  axis-cylinder,  and  ganglion-cells,  gray  (gray  matter). 
The  gray  matter  is  more  vascular  than  the  white.  During  life 
it  exhibits,  in  the  presence  of  sensitive  reagents,  a  slightly  acid 
reaction. 

We  owe  our  first  accurate  knowledge  of  the  histology  of  the  central  nervous 
«ystern,  as  was  staled  in  the  first  lecture,  to  Ehrenberg,  Keniak,  and  Hannover. 
After  Hannover,  Ilelmholz,  in  1842,  recognized  in  invertebrates  the  true  relations 
between  ganglion-cells  and  nerve-fibres.  In  1844,  KöUiker  discovered  that  a 
double-contoured  nerve  might  arise  from  a  cell.     In  1850  Rudolph  Wagnc^r  dis- 


44  LECTURES   ON   THE   CENTRAL   NERVOUS   SYSTEM. 

covered,  in  working  on  the  electric  organ  of  the  torpedo,  that  a  single  ganglion- 
cell  may  send  out  two  sorts  of  processes,  of  which  only  one,  the  axis-cylinder 
process,  is  continued  into  a  nerve  ;  and  in  1854  Remak  observed  the  same  thing 
in  the  great  ganglion-cells  of  the  spinal  cord.  Deiters,  in  1865,  proved  that  this 
was  true  of  all  ganglion-cells.  Our  knowledge  of  these  conditions  has  been  in- 
creased by  the  labors  of  Gerlach,  Max  Schultze,  Waldeyer,  Jolly,  A.  Key  and  G-. 
Retzius,  Betz,  Bevan  Lewis,  Obersteiner,  Freud,  and  many  others.  So  many 
have  turned  their  attention  and  efforts  to  this  most  difficult  region  of  histology 
that  a  memoir  which  appeared  at  the  beginning  of  1887  (Napsen)  enumerated 
341  works  on  nerve-fibres  and  ganglion-cells.  More  recent  and  profound  works 
on  the  neuroglia  are  those  of  Boll,  Ranvier,  and  Gierke. 


LECTURE  IV. 

THE   CONVOLUTIONS    AND    FISSURES   OF   THE   SURFACE  OF   THE 

CEREBRUM.  ' 

Gentlemen  :  It  is  not  so  very  long  ago  that  the  study  of 
the  structure  of  the  brain  surface  possessed  very  little  interest 
for  the  anatomist  and  none  at  all  for  the  practicing  physician. 
Nor  is  it  a  very  long  time  since  order  was  brought  out  of  the 
seeming  chaos  of  the  convolutions  of  the  brain,  so  that  clear  and 
definite  cuts  have  taken  the  place  of  the  old  plates,  concerning 
which  an  author  pertinently  remarked  that 
they  were  a  better  representation  of  a  dish  of 
macaroni  than  of  the  brain.  Interest  was  first 
awakened  in  regard  to  the  human  brain  after 
physiology  and  pathology  had  shown  the  dif- 
ferent   results  of   irritation,    extirpation,   and   Brain  ot^human  embryo 

!•  •  !•  i        i.1,  i'ü*  i.  of  13  weeks. 

disease,  varyuig  according  to  the  dmerent 
convolutions  attacked.  It  is,  therefore,  of  importance,  gentlemen, 
that  you  learn  to  know  thoroughly  the  arrangement  of  these  con- 
volutions and  the  course  of  the  fissures  which  separate  them. 
By  word  and  diagram  alone  it  will  be  impossible  for  me  to  make 
you  as  thoroughly  acquainted  with  these  structures  as  you  should 
be.  Here  again  it  is  necessary  for  you  to  take  a  fresh  brain, 
and,  following  my  lecture,  trace  out  for  yourselves  sulcus  after 
sulcus  and  convolution  after  convolution. 

The  primarily  lens-shaped  hemispheres  grow,  as  you  know, 
toward  tlio  front  and  backward.  Only  in  the  middle,  at  a  point 
corresponding  to  the  corpus  striatum  within,  the  surface  docs 
not  expand  as  rapidly,  and,  hence,  becomes  more  depressed  than 
the  surrounding  parts.  The  depression  which  thus  exists  near 
the  point  of  origin  of  the  hemispheres  is  called  the  fossa  or 
fissure  of  Sylvius,  and  that  part  which  lies  in  the  depression  the 

(45) 


46 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


island  of  Reil.  The  island  is,  therefore,  that  part  of  the  cortex 
which  immediately  adjoins  the  ganglia  of  the  cerebrum.  At 
first  it  lies  on  the  surface,  but  Httle  by  little  it  is  covered  in  by 
the  overlapping  hemispheres. 

You  will  easily  find  the  fissure  of  Sylvius  in  the  adult 
brain.  It  is  the  largest  of  the  sulci,  and  on  separating  its  walls 
you  will  discover  the  island,  and  see  that  it  is  traversed  by  a 
number  of  perpendicular  and  oblique  sulci.     In  the  sixth  month 

Gca  Sc 


Fig.  27. 

The  left  hemisphere  with  the  Assure  of  Sylvius  drawn  apart  in  order  to  show  the  con- 
volutions in  the  island  of  Reil  (In).  Se,  sulcus  centralis;  Gca,  Ocp,  gyrus  centralis, 
anterior  and  posterior ;  Fop,  flssura  parieto-occipitalis.     (After  Henle.) 

of  pregnancy  the  two  divisions  of  the  fissure  of  Sylvius — the 
anterior  and  posterior — are  plainly  to  be  seen.  All  the  rest  of 
the  brain  is  still  smooth.     (Compare  Fig.  7.) 

After  this  period,  furrows  (sulci  or  fissures)  are  developed 
on  the  surface  of  the  hemispheres  by  means  of  local  elevations 
which  increase  more  and  more  during  the  later  months  of  foetal 
life  until  birth,  at  which  time  almost  all  the  fissures  and  convo- 
lutions which  the  adult  brain  will  possess  are  clearly  marked  out. 

The  following  purely  diagrammatic  drawings  may  serve  as 


CONVOLUTIONS    AND    FISSURES    OF    SURFACE    OF   CEREBRUM.       47 

a  guide  in  your  study  of  the  surface  of  the  brain.  Only  the 
most  important  constant  convolutions  and  fissures  are  therein 
considered.  The  simple  diagram  of  Ecker,  of  which  they  are 
reproductions,  impresses  itself  more  easily  on  the  memory  than 
a  representation  of  a  real  brain  which  shows  all  the  shallower 
fissures,  which  are  inconstant,  alongside  the  deeper  and  more 
constant  ones. 

First,  let  us  look  up  the  fissure  of  Sylvius;  it  divides  the 


Fig.  28. 


Lateral  view  of  the  brain.    The  convolutions  and  lobes  are  marked  in  Roman  letters,  the 
fissures  and  sulci  in  italics.    (After  Ecker.) 

greater  part  of  the  temporal  lobe  from  the  rest  of  the  brain.  We 
can  observe  two  branches — a  long  anterior  and  a  short  posterior 
and  ascending  branch.  The  mass  of  brain  which  lies  at  their 
junction  and  covers  the  island  is  called  the  operculum.  If  we 
separate  those  portions  of  the  brain  which  surround  the  fissure 
of  Sylvius,  as  is  done  in  Fig.  27,  the  island  lies  in  full  view.  We 
see  that  it  is  traversed  by  a  deep  fissure,  passing  obliquely 
upward  and  backward, — the    sulcus   centralis    insula?, — whicli 


48  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

divides  it  into  two  lobules.  The  anterior  lobule  is  divided  by 
several  perpendicular  fissures  into  3-4  gyri  breves  insulae.  The 
posterior  lobule  is,  apparently,  one  single  longer  convolution, — 
the  gyrus  longus.  It  borders  directly  on  the  temporal  lobe.  In 
the  operculum  there  begins  an  important  fissure  which  ascends 
to  the  margin  of  the  hemisphere,  but  is  separated  from  the  latter, 
as  well  as  from  the  fissure  of  Sylvius,  by  brain-substance.  This 
is  the  sulcus  centralis,  or  central  fissure.  Observe  it  in  Fig.  28 ; 
it  divides  the  frontal  from  the  parietal  lobe.  All  that  lies  below 
the  fissure  of  Sylvius  is  called  the  temporal  lobe.  In  front  of 
the  central  fissure  lies  the  anterior  central  convolution ;  behind 
it,  the  posterior  central  convolution.* 

The  resfion  in  front  of  the  anterior  central  convolution,  the 
frontal  lobe,  is  divided  by  two  fissures,  the  superior  and  inferior 
frontal  fissures,  into  three  convolutions, — superior,  middle,  and 
inferior  frontal  convolutions.  These  are  not  always  sharply 
defined  along  the  whole  length  of  the  frontal  lobe,  inasmuch  as 
the  frontal  fissures  are  often  interrupted  in  their  course  by  lüis 
de  passage.  You  will  easily  discover  these  three  divisions  of  the 
frontal  lobe  lying  next  to  each  other  in  all  brains,  and  will 
observe  that  the  lower  frontal  convolution  (also  called  third 
frontal  convolution)  takes  part  in  forming  the  operculum.  Very 
often  there  is  found  at  the  posterior  end  of  the  inferior  frontal 
fissure  another  fissure  at  right  angles  to  it,  which  bounds  the 
anterior  central  convolution  in  front  and  is  called  the  prse-central 
fissure. 

[The  lower  frontal  convolution  is  broader  in  Europeans  than  in  other  races. 
In  the  brain  of  Gambetta,  who  was  a  great  orator,  it  was  twice  as  broad  as  usual.] 

The  temporal  lobe  is  traversed  by  several  fissures,  which  run 
parallel  to  the  fissure  of  Sylvius  and  divide  the  lobe  more  or 
less  sharply  into  an  upper  (or  first),  a  middle  (or  second),  and  a 
lower  (or  third)  temporal  convolution.  Generally  only  the  two 
first  of  these  are  clearly  distinguishable  throughout  their  whole 
length.  % 

*  Circonvolutlon  frontale  ascendente.    ^  ^^  ^^^  ^^^^^^^  ^^.^^^^^ 
Circonvolution  parietale  ascendente,  S 


CONVOLUTIONS    AND    FISSURES    OF    SURFACE    OF    CEREBRUM.       41) 

Observe  now  the  region  caudad  of  tlie  central  fissure  and 
above  the  temporal  lobe.  It  is  called  the  parietal  lobe.  It  is 
divided  into  a  superior  and  an  inferior  parietal  lobe  by  a  sulcus, 
which  passes  in  a  curve  around  the  end  of  the  fissure  of  Sylvius 
and  the  end  ol'  the  first  temporal  fissure,  and  is  called  the  inter- 
parietal fissure.  There  is  nothing  to  mark  the  division  between 
the  superior  parietal  lobe  and  the  posterior  central  convolution, 
unless,  as  often  happens,  a  branch  of  the  interparietal  fissure 


Fig.  29. 
Lateral  view  of  the  brain.    For  explanation,  see  Fig.  28.     (After  Ecker.) 

passes  upward  toward  the  margin  of  the  hemisphere.  In  this 
case,  of  course,  the  connecting  convolution  is  much  narrower. 

That  part  of  the  inferior  parietal  lobe  which  surrounds  tlie 
fissure  of  Sylvius  is  called  the  gyrus  marginalis.* 

The  part  lying  just  back  of  this,  and  arching  around  tlie 
end  of  the  superior  temporal  fissure  is  called  the  gyrus  angu- 
laris.    The  former  you  will  discover  at  once  in  every  brain  ;  the 

•  Marked  "(J.  Hupra-marginulis"  in  the  cut  (Fig.  28). 
4 


50 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


latter  you  will  have  to  be  at  some  pains  to  distinguish.  You 
will  find  it  in  the  space  which  is  bounded  above  by  the  inter- 
parietal fissure  and  below  by  the  superior  temporal  fissure,  its 
posterior  portion,  indeed,  surrounding  the  end  of  the  latter. 

Do  not  always  expect,  gentlemen,  to  find  the  interparietal 
fissure  running  its  whole  course  without  a  break.  Often  enough 
it  is  broken  into  two  or  more  parts  by  pZis  de  passage^  which 
are  usually  found  in  its  posterior  third.  Its  posterior  portion 
extends  into  the  occipital  lobe. 

This  occipital  lobe  is  not  in  all  brains  so  uniformly  divided 

by  its  sulci  that  we  can  always 
find  the  three  convolutions 
described  by  writers,  viz.,  first 
(upper),  second  (middle),  and 
third  (lower)  occipital  convolu- 
tions, easily  and  without  arti- 
ficial refinement. 

It  is  often  separated  from 
the  parietal  lobe  by  an  addi- 
tional occipital  fissure  (not 
shown  in  the  figure),  which 
passes  up  perpendicularly  be- 
hind the  gyrus  angularis. 
The  line  of  division  from  the 
temporal  lobe  is  a  horizontal 
fissure,  appearing  like  a  continuation  of  the  inferior  temporal 
fissure,  and  called  the  inferior  occipital  sulcus.  The  angle  be- 
tween these  occasionally  continuous  fissures  bounds  the  temporal 
lobe.  At  the  upper  and  anterior  part  it  is  continuous  with  the 
parietal  lobe.  This  connection  is  divided  into  the  bridging  con- 
volutions by  the  interparietal  fissure,  which  passes  through  it 
longitudinally. 

After  noting  all  these  convolutions  and  fissures,  divide  the 
brain  into  halves  by  cutting  down  through  the  great  fissure  and 
study  the  median  surface. 


^SleBc  HO  Vorderhirn 
und  Iwisdiaihim. 
tusaiuaeaslassen.. 

Fig.  30. 

Inner  aspect  of  the  embryonic  hemi- 
sphere, shown  in  Fig.  7.  Shows  the  inner 
lower  border  of  the  hemisphere,  which  be- 
comes thickened  into  the  white  medullary 
line  of  the  fornix.  The  latter,  however,  only 
becomes  medullary  after  birth. 

Stelle  wo  Vorderhim  und  Zwischenhirn  zusam- 
menxlnsKen,  Point  where  the  fore-brain  and  mid-brain 
meet. 


CONVOLUTIONS    AND    FISSURES    OF    SURFACE    OF    CEHEBKUM.       51 

The  most  important  parts  of  the  median  hemisphere-wall 
have  been  described  in  the  preceding  lecture,  while  we  were 
studying-  its  development.  I  will  only  remind  you  that  we  then 
learned  that  the  margin  of  the  hemisphere  thickened  into  the 
ibrnix,  followed  the  growing  hemisphere  in  a  curve ;  that  for- 
ward, where  the  corpus  callosum  passes  through,  that  portion 
of  tlie  inner  wall  which  lies  between  the  latter  and  the  fornix, 
remains  as  the  septum  pellucidum. 

Taught  thus  by  the  history  of  its  development,  you  will 


fimbria    or    forni*. 

Fig.  31. 

Sagittal  section  thruugh  the  middle  of  an  adult  brain.  The  posterior  portion  of  the 
tbalamu.s,  the  pedunculus  cerebri,  etc.,  have  been  removed  in  order  to  show  the  inner 
surface  oif  the  temporal  lobe. 

understand  the  sections  made  through  the  adult  brain.  In  the 
s])ecimen  from  wliich  Fig.  31  is  taken,  as  well  as  in  the  embry- 
onal brain  (Fig.  30),  all  parts  lying  caudad  of  the  middle  of  the 
tlialamus  are  cut  off,  because  they  cover  the  under  side  of  the 
temporal  lobe  and  prevent  us  from  following  up  the  course  of 
the  fornix. 

Now,  on  the  longitudinal  section,  you  see  in  the  centW3  the 
inter-brain,  or,  rather,  the  tlialamus,  which  has  developed  from 
its  lateral  wall.  Along  the  boundary  between  it  and  the  cere- 
brum Hes  the  curved  margin  of  the  hemisphere,  thickened  to  a 


52 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


white  band  of  medullary  substance, — the  fornix.  Near  the 
junction  of  the  thalamus  and  mid-brain  it  rises  close  to  the 
base  of  the  brain,  passes  dorsad  as  the  pillars  of  the  fornix, 
accompanies  the  margin  of  the  hemisphere  still  farther,  curves 
around  it  into  the  temporal  lobe,  and  ends  in  the  apex  of  the 
latter. 

The  horizontal  mass  of  transversely  divided  fibres  above  it 
belongs  to  the  corpus  callosum.  In  its  anterior  part  you  will 
distinguish  the  knee,  in  its  posterior  part  the  splenium,  and  be- 


fiihbfta  or   lotn'm. 
Fig.  32. 
For  explanation,  see  Fig.  31. 

tween  the  two  the  body.  Between  the  fornix  and  the  corpus 
callosum  lies  the  triangular  field  of  the  septum.  Besides  this, 
you  can  see,  just  in  front  of  and  below  the  fornix,  the  anterior 
commissure,  and  in  the  middle  the  commissura  media, — both, 
of  course,  in  cross-section. 

That  portion  of  the  hemisphere-wall  which  lies  above  the 
corpus  callosum  is  traversed  by  few  and  rather  constant  fissures. 
First,  parallel  with  the  corpus  callosum,  is  the  sulcus  calloso- 
marginalis.  Behind,  it  turns  upward  to  the  crest  of  the  hemi- 
sphere and  terminates  in  a  little  indentation  behind  the  posterior 


CONVOLUTIONS    AND    FISSURES   OF   SURFACE   OF    CEREBRUM.       53 

central  convolution.  That  part  lying  in  front  of  and  above  this 
fissure  is  considered  as  belonging  to  the  superior  frontal  convo- 
lution. The  convolution  between  it  and  the  corpus  callosum  is 
called  the  gyrus  fornicatus.  A  glance  at  a  specimen,  or  at  our 
cut,  shows  that  the  gyrus  fornicatus  becomes  widened  posteriorly, 
and  passes  up  over  the  crest  of  the  hemisphere  to  become  con- 
tinuous with  the  superior  parietal  lobe.  This  widened  portion 
is  called  the  praecuneus.  Directly  in  front  of  the  praecuneus 
lies  a  region  of  the  cortex  which,  exteriorly,  is  continuous  with 
both  central  convolutions  and  connects  them.  It  is  called  the 
paracentral  lobule.  Posteriorly,  the  praecuneus  is  bounded  by  a 
deep  fissure,  which  usually  passes  over  somewhat  to  the  exterior 
surface  of  the  hemisphere.  It  is  called  the  parieto-occipital 
fissure.  This  parieto-occipital  fissure  sometimes  passes  beyond 
the  inner  surface  of  the  brain,  and  runs  out  over  the  outer 
surface  as  a  deep  perpendicular  fissure.  This  is  especially  apt 
to  occur  in  the  brains  of  idiots. 

The  fissura  calcarina  joins  the  parieto-occipital  sulcus  at 
an  acute  angle.  This  fissure  lies  exactly  in  the  wall  of  the 
posterior  horn  of  the  lateral  ventricle,  which  has  been  mentioned 
before.  Tlie  brain-wall,  displaced  inward  by  it,  can  be  seen  as 
an  elongated  swelling  in  the  posterior  horn.  This  swelling  is 
known  as  the  calcar  avis  or  pes  hippocampi  minor.  The  tri- 
angular portion  of  cortex  inclosed  between  the  fissures  last 
described  is  known  as  the  cuneus.  Examine  the  point  of  this 
region  and,  superficially  or  deeply,  you  will  find  a  little  convo- 
lution connecting  it  with  the  gyrus  fornicatus,  which  passes  by 
in  front  of  the  wedge-shaped  cuneus.  Notice  this  comparatively 
narrow  part  of  the  gyrus  fornicatus.  You  see  that  it  passes  on 
as  a  rapidly-broadening  convolution  to  the  apex  of  the  temporal 
lol)e,  where  it  ends  in  a  hook-shaped  process, — the  uncus  or  gyrus 
uncinatus.  This  ])art  of  the  gyrus  fornicatus  lying  in  the  tem- 
])oral  lobe  is  called  the  gyrus  hippocampi.  Posteriorly  (as  you 
see  in  tlie  cut),  a  small,  longish  convolution  of  the  occipital  lobe 
joins  the  gyrus  hippocampi.     It  is  called  the  lobus  lingualis. 


54  LECTURES    ON    THE   CENTRAL    NERVOUS    SYSTEM.    . 

As  I  showed  you  before,  the  fornix  forms  the  margin  of 
the  hemispheres.  The  first  convolution  outside  of  this  margin 
— a  convokition,  therefore,  which  lies  close  to  the  fornix — is 
the  gyrus  hippocampi  just  mentioned.  To  the  other  side  of 
it  lies  the  cavity  of  the  ventricle, — the  inferior  horn.  At  this 
point  the  ventricle  is  separated  from  the  general  cavity  of 
the  skull  by  a  thin  membrane,  bearing  the  continuation  of  the 
choroid  plexus,  which  is  attached  to  the  fornix  throughout  its 
entire  course. 

The  gyrus  hippocampi  may  be  regarded  as  the  marginal 
convolution  of  the  hemisphere.  This  margin,  a  long,  thin,  white 
stripe,  is  directly  continuous  with  the  fornix  above.  It  is  called 
the  fimbria  (Fig.  19,  F.I). 

The  gyrus  hippocampi  is  pushed  out  into  the  cavity  of  the 
inferior  horn  by  a  fi.ssure  on  its  outer  surface, — the  fissura  hip- 
pocampi. The  swelling  which  is  thus  produced  and  which  ex- 
tends along  the  whole  floor  of  the  inferior  horn  has  for  ages 
been  called  the  cornu  ammonis,  or  pes  hippocampi  major. 

From  the  fact  that  the  cortex  of  the  gyrus  hippocampi  is 
doubled  in  by  the  fissura  hippocampi  before  it  ceases  and  leaves 
the  medullary  matter  bare,  ^  peculiar  and  complicated  appear- 
ance is  presented  on  cross-section.  Over  the  general  surface  of 
the  brain  the  gray  matter  is  continuous,  as  shown  in  Fig.  33  A; 
but  on  the  gyrus  hippocampi  it  ceases  close  to  the  ventricle,  as 
shown  in  Fig.  33  B,  and  leaves  the  white,  somewhat  curved 
edge  (the  fimbria)  free.  The  bending  or  doubling  in  which 
it  undergoes  before  it  ceases  is  shown  in  Fig.  33  B.  Between 
the  gyrus  hippocampi  and  the  free  medullary  margin  of  the 
hemisphere  (fimbria — fornix)  there  lies  a  small  convolution  (pur- 
posely not  mentioned  before),  which  passes  from  the  end  of  the 
corpus  callosum  to  the  apex  of  the  temporal  lobe,  and  therefore 
takes  part  in  the  configuration  of  the  cornu  ammonis.  You 
will  please  look  up  this  convolution  in  the  sagittal  section  (Fig. 
32)  in  order  to  make  clear  its  situation  in  relation  to  the  fornix 
and  the   cornu   ammonis.     It  is  called  the  gyrus  dentatus,  or 


CONVOLUTIONS    AND    FISSURES   OF    SURFACE    OF    CEREBRUM.       55 


fascia  dentata.  As  you  see,  it  lies  just  in  front  of  the  involution 
of  the  cortex  of  the  gyrus  hippocampi,  by  the  fissure  of  the  same 
name,  and  its  cross-section,  therefore,  is  not  correctly  represented 
by  Fig.  33  B,  but  rather  by  Fig.  34. 

The  cornu  ammonis  is,  therefore,  the  bulging  in  the  floor 
of  the  ventricle,  Avhich  is  caused  by  the  pushing  in  of  the  gyrus 
hippocampi  by  the  fissure  of  the  same  name.  From  the  cessa- 
tion of  the  cortex  just  at  this  point,  from  the  fact  that  the 
margin  of  the  hemisphere  (fimbria  and  gyrus  dentatus)  runs 
along  over  this  involution,  arises  the  comulicated  cross-section  of 
the  coniu  ammonis. 


l^»^V.Ji»_ 

HHto 

~- 

"^^IZZ. 

1 

k^- 

I 

1 

mm^ 

^^ 

J 

■ho 

-    ■      1 

1 

[>£: 

~- 

HI 

■ 

id 

Fig.  SS  a  . 


Fig.  33  B. 

Unfer,  Inferior. 


Fig.  34. 


The  relation  of  the  gyrus  hippocampi  to  the  inferior  horn 
of  the  lateral  ventricle  is  made  clear  by  Figs.  19,  32,  and  38. 

The  gyrus  fornicatus  and  its  continuation,  the  gyrus  hip- 
pocampi, are  developed  early  in  fcetal  life.  Dorsad  of  the 
margin  of  the  hemisphere  (arch  of  the  fornix),  there  is  devel- 
oped in  all  mammals  a  furrow  which  lies  parallel  with  the  fornix 
and  accompanies  it  into  the  temporal  lobe, — the  fissura  hippo- 
campi. The  convolution  between  it  and  the  fornix  is  the  gyrus 
hippocampi.  Anteriorly,  the  fibres  of  the  corpus  callosum  pass 
transversely  through  it,  and  in  this  region  it  is  called  the  gyrus 
fornicatus.  Farther  back,  however,  it  is  called  the;  gyrus  hip- 
pocampi, and  lies  next  to  the  foniix.     In  the  lower  animals  the 


56  LECTURES   ON    THE    CENTRAL    NERVOUS    SYSTEM. 

corpus  callosum  and  the  gyrus  foniicatus  are  very  short.  Only 
in  men  and  apes  is  the  corpus  callosum  so  long  that  the  begin- 
ning of  the  gyrus  hippocampi  lies  in  the  temporal  lobe.  If  you 
will  look  at  the  upper  surface  of  the  corpus  callosum,  you  will 
see  on  each  side  of  it  a  thin,  gray,  longitudinal  line  (Fig.  18,  Lt). 
It  is  the  continuation  of  the  atrophic  convolution  met  in  the  pes 
hippocampi  major, — the  gyrus  dentatus.  We  call  it  the  stria 
longitudinalis  Lancisi. 

All  the  convolutions  which  lie  near  the  margin  of  the  hemi- 
sphere— the  gyrus  foniicatus,  the  gyrus  hippocampi,  the  stria 
longitudinalis  Lancisi,  and  the  fascia  dentata — are  very  strongly 
developed  in  animals  having  highly  perfected  organs  of  smell. 
In  those  which,  like  human  beings,  have  small  olfactory  lobes, 
they  are  somewhat  atrophied,  and  in  the  dolphin,  which  has  no 
olfactory  lobe,  they  are  totally  undeveloped  (Zuckerkandl).  At 
the  posterior  end  of  the  corpus  callosum  we  sometimes  see  a  short 
convolution  which  passes  in  the  direction  of  the  fornix  and  be- 
comes incorporated  with  it ;  it  is  the  gyrus  callosus,  which  is  only 
present  in  man  as  a  very  atrophic,  imperfect,  and  inconstant 
structure. 

On  a  fresh  brain  you  may  see  the  gyrus  unciatus  at  the 
apex  of  the  temporal  lobe,  and  from  there  follow  the  gyrus  hip- 
pocampi upward.  Then  observe  the  prominent  arch  of  the 
fornix  as  it  passes  over  the  posterior  part  of  the  thalamus,  and 
note  how  it  ends  in  the  fimbria,  which  is  visible  nearly  to  the 
end  of  the  gyrus  hippocampi  as  a  white  medullary  line. 
Lastly,  make  a  cross-section,  which  may  explain  the  relations 
of  the  foregoing  structures. 

On  the  base  of  the  brain,  with  the  exception  of  the  hippo- 
campal  fissure,  which  really  belongs  to  the  median  surface,  there 
are  few  sulci  of  importance.  On  the  under  surface  of  the  frontal 
lobe  are  the  orbital  and  the  olfactory  fissures.  The  convolutions 
between  them  are  regarded  as  continuations  of  the  frontal  con- 
volutions, and  receive  the  names  of  the  frontal  convolutions  with 
which  they  are  respectively  continuous.     The  under  surface  of 


CONVOLUTIONS    AND    FISSURES    OF    SURFACE    OF    CEREBRUM.       57 

the  occipital  and  temporal  lobes  is  fissured  mainly  in  an  antero- 
posterior direction.  A  third  and  fourth  temporal  sulcus  is  often 
found.  The  latter,  which  extends  over  into  the  temporal  lobe, 
is  called  the  occipito-temporal  fissure.  It  separates  the  gyrus 
hippocampi  from  the  convolutions  of  the  temporal  lobe.  The 
temporal  convolution  lying  just  outside  of  this  fissure  (fourth 
temporal  convolution)  has  received  the  name  of  gyrus  occipito- 
temporalis. 

Our  knowledge  of  tlie  course  of  the  convolutions  comes  from 
Burdacli  {median  surface^,  Leuret,  Gratiolet,  Meynert  {com- 
parative anatomy),  Bischoß\  Ecker,  Pansch  {growing  and  adidt 
brain).  Besides  these  there  are  numerous  investigators  as  to 
separate  localities,  e.g.,  Broca  and  Zucherhandl  on  the  convolu- 
tions near  the  margin  of  the  hi'ain,  Eherstaller  and  Giddherg 
on  the  island^  and  Rüdin ger  on  the  interparietal  fissure.  Agaiii^ 
n:e  possess  a  cmisiderahle  7iumher  of  monographs  on  the  surface 
of  the  hrain  of  many  mammals.  {Anthropomorphous  apes,  hy 
Bischojf ;  lemurs,  hy  Flower  and  hy  Gervais;  tohales,  hy 
Guldherg  ;  ungulates,  hy  Krueg ;  carnivoi^ous  animals,  hy 
Meynert  and  Pansch,  and  many  others.)  Tlie  numerous  varia- 
tions in  the  course  of  the  individual  convohitions  and  fissures 
irhich  may  occur  in  man  are  not  only  mentioned  hy  a  majority 
of  the  ahove  writers,  hut  have  found  an  investigator  of  their  own 
in  D.  Sernow. 

It  does  not  lie  within  the  scope  of  these  lectures,  gentle- 
men, to  impart  the  rich  store  of  facts  which  physiology  has 
brouglit  to  liglit  respecting  the  various  cerebral  structures. 
Our  knowledge  of  the  functions  of  the  cortex  is,  as  yet,  in  its 
infancy,  and  is  in  no  respect  complete.  I  must  refer  you  to  the 
text-books  of  physiology,  in  many  of  which  you  will  find  ex- 
cellent chapters  on  the  subject.  In  general,  it  may  be  said  that, 
NO  far  as  the  phenomena  which  follow  an  injury  to  the  cortex 
are  concerned,  more  is  positively  known  a})out  human  beings 
than  about  animals.  The  following  is  a  short  summary  of  these 
.symptoms: — 


58 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


Injuries  which  involve  the  normal  structure  and  function 
of  the  cortex  give  rise  in  the  human  being  to  symptoms  differ- 
ing according  to  the  part  injured.  Up  to  the  present  time  there 
have  been  several  hundred  carefully  observed  cases  of  disease 
of  the  cortex,  and  by  comparing  them  with  one  another  we  can 
arrive  at  the  following  conclusions: — 


Fig.  35. 
The  convolutions  on  the  base  of  the  brain  (diagrammatic).    (After  Ecker.) 

Motor  symptoms  of  irritation  (from  the  twitching  of  single 
muscles  up  to  epilepsy)  may  arise  from  any  part  of  the  cortex, 
but  there  exists  a  zone  of  the  brain  embracing  both  central 
convolutions,  injury  to  which  is  almost  always  accompanied  by 
motor  disturbances  on  the  opposite  side  of  the  body.  The  dis- 
turbances may  be  divided  into  symptoms  of  irritation  and  symp- 


CONVOLUTIONS    AND    FISSURES   OF    SURFACE   OF   CEREBRUM.       59 

toms  of  degeneration.  The  symptoms  of  irritation  are  shown 
by  convulsive  movements ;  the  symptoms  of  degeneration  by  a 
greater  or  less  inability  to  set  the  muscles  in  motion  at  w^ill, 
oftentimes  only  in  a  sense  of  weakness,  or  by  awkwardness  in 
executing  some  complicated  movement. 

From  careful  analysis  of  known  cases  of  disease,  it  is  cer- 
tain that,  in  injury  of  the  upper  part  of  both  central  convolutions 
and    the  paracentral  lobule,  the  motor  disturbances  are  most 


Fig.  36. 
liateral  view  of  brain.    The  " motor  region  "  shaded.    (After  Exner.) 

prominent  in  the  legs,  that  when  the  lower  end  of  the  central 
convolutions  is  involved  the  regions  supplied  by  the  facial  and 
hypoglossus  suffer  most,  and  that  motor  disturbance  of  tlie 
upper  extremities  follows  when  the  middle  and  a  part  of  the 
upper  third  of  these  convolutions  are  involved.  The  divisions 
between  these  separate  "  centres  "  are  not  sharply  drawn. 

Comph^te  destruction  of  separate  portions  of  the  cortex  in 
the  liuman  being  may  lead  to  permanent  paralysis  of  the  muscles 


60  LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 

standing-  in  relation  to  the  affected  part.  The  paralyzed  muscles 
almost  always  fall  into  a  contractured  state. 

Injuries  which  involve  the  cortex  of  the  inferior  frontal 
convolution  or  the  island  of  Reil,  if  situated  on  the  left  side, 
generally  result  in  the  more  or  less  complete  loss  of  speech, 
although  the  vocal  organs  may  still  be  normally  innervated  and 
the  person  affected  may  perfectly  understand  all  said  by  others. 
It  appears  that  the  ability  to  understand  whatever  is  said  in  a 
loud  voice  is  lost  when  the  superior  temporal  convolution  is 
involved. 

Disease  in  the  region  of  the  occipital  lobe  may  lead  to  dis- 
turbances of  vision,  which  may  be  present  only  as  a  dimness  of 
vision  or  as  a  blindness  on  the  outer  side  of  the  eye  on  the 
affected  side  and  on  the  inner  side  of  the  opposite  eye. 

Sensibility  may  also  suffer  from  affections  of  the  cortex  of 
the  brain.  The  most  commonly  observed  symptoms  are  feelings 
of  numbness,  heaviness,  and  marked  disturbance  of  the  muscle 
sense.  The  sense  of  touch  is,  as  a  rule,  dull  so  far  as  the  judg- 
ment of  the  patient  is  concerned,  but  very  slight  sensory  irrita- 
tions may  still  be  felt,  if  they  are  of  a  simple  character  (touching 
with  a  feather,  point  of  a  needle,  etc.).  We  do  not  know  of  any 
particular  parts  of  the  cortex  disease  of  which  especially  leads 
to  disturbances  of  sensation.  At  all  events,  such  disturbances 
may  follow  diseases  of  the  central  convolutions  and  their  vicinity. 

The  paralyses  which  follow  disease  of  the  cortex  are  hardly 
ever  so  complete  as  those  which  are  caused  by  destruction  of  the 
peripheral  nerves  or  their  proximal  end  in  the  spinal  cord.  In 
animals  it  is  generally  impossible  to  produce  a  permanent 
paralysis  by  removing  the  cortex  of  the  motor  zone  or  the  whole 
portion  of  the  brain  which  contains  that  zone.  We  can,  how- 
ever, almost  without  fail,  produce  contractions  of  definite 
muscles  by  irritating  certain  circumscribed  portions  of  the 
cortex. 

This  much,  however,  has  been  made  certain  by  experiments 
upon  animals  and  by  pathology,  that  the  actual  motor  centres 


CONVOLUTIONS    AND    FISSURES    OF    SURFACE    OF    CEREBRUM.       61 

lie  far  back  between  the  corpora  quadrigemina  and  the  spinal 
cord ;  that  they  are,  however,  so  connected  with  centres  situated 
in  the  cortex  that  irritation  of  the  latter  gives  rise  to  movements. 
There  is  a  conflict  of  opinion  as  to  the  nature  and  importance 
of  the  influence  exercised  by  the  higher  centres  over  the  lower. 
For  this  reason  we  study  with  the  utmost  scrupulousness  those 
phenomena  which  follow  the  removal  of  portions  of  the  cortex. 
Doubtless  the  importance  of  the  role  played  by  the  cortex  difters 
in  dift'erent  animals.  While  in  the  lower  animals  the  removal, 
even  of  the  whole  cerebrum,  does  not  prevent  the  vigorous  exe- 
cution of  coarser  movements,  yet  in  mammals  the  destruction 
of  even  circumscribed  portions  of  the  motor  zone  gives  rise  to 
temporary  paralysis,  and  in  the  human  being  disease  of  rela- 
tively small  parts  of  the  cortex  often  leads  to  a  permanent 
paralysis.  It  is  evident  that  all  motor  and  many  sensori-psychic 
functions  may  start  from  deep-lying  centres,  but  the  higher  we 
ascend  in  the  scale  of  animal  life  the  more  is  the  cortex  con- 
cerned in  cerebral  activity,  and  consciousness  plays  a  more 
prominent  part.  Man  has  reached  a  stage  in  this  connection 
in  which  many  of  the  functions  cannot  be  performed  without 
the  participation  of  the  cortex.  In  mammals  all  possible  degrees 
of  variation  are  observed.  Thus  is  explained  the  fact  that  irri- 
tation of  certain  tracts  of  cortex  will  give  rise  to  muscular 
action,  and  yet  movements  may  be  executed  after  those  particular 
parts  of  cortex  have  been  removed.  In  man  the  greater  part 
of  the  surface  of  the  hemispheres  has  become  indispensable  to 
the  proper  performance  of  such  movements. 


LECTURE  y. 

THE    CORTEX   OF   THE   FORE-BRAIN,  THE  WHITE    SUBSTANCE   OF   THE 
HEMISPHERES,    THE    COMMISSURES,    AND    THE    CORONA    RADIATA. 

Gentlemen  :  In  the  previous  lecture  you  were  taught  the 
appearance  of  the  surface  of  the  brain,  the  fissures  which  traverse 
it,  and  the  convolutions  situated  thereon. 

To-day's  lecture  is  intended  to  give  you  a  more  intimate 
knowledge  of  the  structure  of  the  cortex,  and  to  place  before 
you  a  general  view  of  the  connections  of  the  various  cortical 
regions  with  one  another  and  with  the  deeper-lying  structures. 

We  know  the  elements  only  which  go  to  make  up  the 
finer  structure  of  the  cortex.  The  actual  connections  between 
these  elements  are  still  hidden  from  us,  and  therefore,  unfortu- 
nately, vve  are  deprived  of  the  very  essentials  for  a  correct  un- 
derstanding of  the  anatomical  substratum  of  the  great  organ  of 
the  mind.  There  is  scarcely  a  doubt  but  that  the  cortex,  taken 
as  a  whole,  may  be  regarded  as  the  region  where  most  of  the 
conscious  mental  processes  take  place ;  that  in  it  is  the  seat  of 
thought,  and  that  from  the  cortex  all  conscious  voluntary  acts 
proceed.  The  whole  hemisphere  is  covered  by  the  cortex.  This, 
however,  has  not  the  same  structure  at  all  points  of  the  con- 
vexity, and  although  we  can  make  out  a  sort  of  fundamental 
type,  yet  there  is  a  wide  departure  from  this  type  in  different 
parts  of  the  cortex,  particularly  in  those  layers  which  contain 
the  ganglion-cells  and  nerve-fibres.  One  structural  type  never 
passes  abruptly  into  another.  Inasmuch  as  the  significance  of 
these  anatomical  variations  is  unknown,  let  us  to-day  only  con- 
sider the  cortex  of  one  region, — of  the  frontal  lobe.  Here,  just 
under  the  pia  mater,  lies  a  layer  of  neuroglia  with  numerous 
glia-cells.     It  contains  a  tliick  net-work  (/  in  the  accompanying 


64 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


cut)  of  very  fine  medullated 
fibres.  Not  until  we  pass  this 
layer  of  neuroglia  do  we  meet 
with  the  real  ganglion-cells  of 
the  cortex.  They  all  have  a 
more  or  less  clearly  defined 
pyramidal  shape,  and  send  out 
apex  processes,  lateral  proc- 
esses, and  axis-cylinders.  The 
location  and  appearance  of  the 
first  two  are  made  clear  in  the 
cut,  but  it  is  more  difficult  to 
recognize  that  process  which 
becomes  an  axis-cylinder.  Ac- 
cording to  Golgi  there  are 
everywhere  in  the  cortex  cells 
with  branched  and  those  with 
unbranched  axis-cylinders.  The 
majority  of  the  processes  are 
directed  inward  toward  the 
white  substance  of  the  hemi- 
spheres. The  deeper  we  go 
into  the  cortex,  the  larger  do 
the  pyramidal  cells  become  and 
the  longer  are  their  apex 
processes.  We  can  divide  the 
cortex  into  several  layers,  ac- 
cording to  the  size  of  the  cells. 
Under  the  glia  layer  (marked 
i)  comes  the  layer  of  small 
cells  (2).     This  passes  imper- 

FiG.  37.— Section  through  the  cortex  of  a  frontal  convolution.  On  the  right  the  cut  is 
taken  from  a  specimen  stained  by  Weigert's  hematoxylin  method  ;  on  the  left,  from  specimens 
treated,  according  to  Golgi,  with  suhhmate.  On  the  right  only  the  fibres,  on  the  left  only  the 
cells,  are  to  be  seen.  The  latter  were  present  in  greater  abundance  than  as  shown  m  the  cut. 
Inasmuch  as  the  spaces  around  the  cells  are  filled  in  when  Golgi' s  method  is  used,  the  latter 
appear  larger  than  they  really  are. 


Gennarischer  Streif,  Line  of  Gennari. 
Interradiäres  Flechtwerk,  Inter-radial  net-work. 


Superradiäres  Flechtwerk,  Super-radial  net-work. 
Tangentialfasern,  Tangential  fibres. 


THE  CORTEX  OF  THE  FOHE-BKAIN,  ETC.  65 

ceptibly  into  the  third  layer  (3),  which  contains 'the  large  corti- 
cal pyramids.  The  next  layer  (4)  consists  of  smaller  and  irregu- 
larly pyramidal  cells.  Possibly,  however,  these  may  be  similar 
to  those  lying-  more  supcn-ficially,  except  that  they  have  not 
reached  their  full  development,  for  they  lie  wedged  in  between 
the  masses  of  medullary  fibres  which  pass  into  the  cortex. 
These  fibres,  after  reaching  the  cortex,  break  up  into  numerous 
fine  fibrils,  and  are  gradually  lost  in  finer  and  more  superficial 
net-Avorks,  or  become  continuous  with  the  axis-cylinders  of  the 
cells.  Aside  from  these  we  see  a  ast  numbers  of  other  medullated 
nerve-fibres  in  the  cortex.  Whence  they  come  or  whither  they 
go  is  still  utterly  unknown. 

Even  though  the  explanation  of  the  ultimate  mechanism 
of  the  organ  of  mind  is  wanting,  still  we  have  of  late  years 
come  nearer  to  it,  chiefly  by  means  of  the  finer  technical  methods 
in  use.  As  long  as  we  cannot  give  all  these  fibres  a  name  cor- 
responding to  tlieir  function,  it  will  be  better  for  the  sake  of 
clearness  (for  instance,  in  researches  in  pathological  anatomy) 
to  give  them  provisional  names.  Let  us  distinguish  (1)  radiating 
medullary  fibres,  (2)  inter-radial  net-work  consisting  mostly  of 
fibres  j)arallel  to  the  surface,  (3)  super-radial  net-work,  and  (4) 
tangential  fibres.  Along  the  boundary  between  the  inter-radial 
and  super-radial  net-works  the  former  becomes  markedly  thick- 
ened. This  layer,  everywhere  visible  as  a  white  line,  is  so 
strongly  marked  in  the  vicinity  of  the  cuneus  as  to  be  easily 
recognized.  It  is  called  the  line  of  Gennari  or,  after  its  later 
describers,  the  line  of  Baillarger,  and,  in  the  vicinity  of  the 
cuneus,  the  line  of  Vicq  d'Azyr.  In  the  occipital  lobe  this  line 
lies  deep  in  the  third  layer,  nearer  the  fourth  than  is  shown  in 
Fig.  37,  whic:h  represents  the  frontal  lobe. 

As  was  pn'viously  stated,  the  cortex  has  not  the  same  struc- 
ture at  all  points  of  the  surface.  Besides  the  peculiarities  im- 
parted to  it  in  the  vicinity  of  the  calcarine  fissure  by  the  line  of 
Gennari,  the  cortex  of  the  gyrus  hippocampi  presents  a  character- 
istic appearance  on  account  of  the  involution  in  the  region  of  the 


Db  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

coriiu  ammoiiis  and   the  intercalation  of  the  atrophic  cortical 
bundle  of  the  gyrus  dentatus. 

The  pyramidal  cells  of  the  cornu  ammonis  are  not  directly 
continuous   with    those    of  the   gyrus  dentatus,   as   might   be 


Fig.  38. 

Section  through  the  base  of  the  brain  and  the  subjacent  gyrus  hippocampi.  The 
choroid  plexus  is  drawn  somewhat  simpler  than  it  really  is  in  the  adult.  JSTotice  how  it 
separates  the  ventricle  from  the  cavity  of  the  skull. 

Oberflächliches  Mark,  Superficial  medullary  matter. 


expected  from  the  diagram,  Fig.  34.  They  end  rather  by  being 
massed  irregularly  together  (at  a  in  Fig.  38),  and  this  irreg- 
ular mass  is  surrounded  by  the  regularly  placed  cells  in  the 
curve  of  the  gyrus  dentatus.     These  and  the  other  layers  which 


THE    CORTEX    OF    THE    FORE-BRAIN,    ETC.  67 

arise  from  the  involution  have,  unfortunately,  received  special 
names.  As  we,  however,  know  what  portions  of  the  general 
cortex  are  represented  by  the  different  structures  of  the  cornu 
ammonis,  it  is  better  to  regard  the  latter  genetically  and  not  dis- 
turb our  comprehension  of  its  arrangement  by  using  the  old 
names.  Let  us  follow  the  cortex  from  below  upward  in  the  ac- 
companying figure.  You  see  that  the  superficial  layer  of  medul- 
lary fibres  becomes  thickened  far  ventrad  of  the  point  where  it  is 
rolled  in.  Nowhere  else  in  the  brain  so  well  as  at  this  point  can 
it  be  seen  that  these  fibres,  which  in  great  part  run  in  the 
longitudinal  axis  of  the  brain,  originate  in  the  radiating  fibres 
below.  Near  the  gyrus  dentatus  a  portion  of  these  fibres  pass 
to  a  somewhat  deeper  layer  of  the  cortex,  while  the  rest  remain 
superficial  and  become  blended  with  the  adjoining  analogous 
layer  of  that  structure.  Here,  as  everywhere  else,  the  radiating 
fibres  pass  inward  from  the  cortex.  In  the  vicinity  of  the  gyrus 
hippocampi,  however,  so  few  of  these  fibres  arise  that  they  do 
not  form  a  thick  medullary  deposit  underneath  the  cortex,  but 
only -a  thin  layer.  This  thin  coating  covers  the  side  of  the  cornu 
ammonis  which  is  toward  the  ventricle,  and  at  the  tip  of  the 
fold  is  gathered  up, into  a  medullary  bundle,  no  longer  covered 
with  gray  matter.  This  is  the  fornix.  Into  it  pass  also  the  few 
fibres  which  spring  from  the  little  gyrus  dentatus. 

The  course  of  many  of  the  cortical  fibres  differs  in  the 
cornu  ammonis  from  their  course  in  other  regions  of  the  cortex. 
Inasmuch,  however,  as  the  origin  and  significance  of  the  whole 
net-work  shown  in  Fig.  37  is  so  uncertain,  you  will  not  be 
specially  interested  in  the  analogous  structures  of  the  cornu 
ammonis.  Of  the  greatest  importance  was  the  discovery  of 
Tuf;zcck,  that  in  progressive  paralysis  of  the  insane  the  net-work 
of  fibres  in  layer  1  is  destroyed,  and  that  tlie  fibres  in  the  deeper 
layers,  down  to  layer  4,  successively  disappear. 

The  nerve-fibres  of  the  cortex  receive  their  medullary  in- 
vestment at  a  very  late  period.  Tins  takes  place  first  in  the 
superior  parietal  lobe  during  the  ninth  foetal  month.     In  the 


68  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

first  month  of  post-foetal  life  a  few  fibres  of  the  anterior  central 
convolution  receive  their  medullary  sheaths.  Later,  in  the  second 
to  third  month,  the  medullary  sheaths  are  developed  in  the 
cortex  of  the  occipital  lobe.  It  is  probable  that  these  conditions 
correspond  to  the  time  when  the  individual  first  begins  to  retain 
memory-pictures  in  the  different  regions  of  the  brain ;  that,  for 
instance,  the  cortex  of  the  visual  centres  is  developed  a^  soon  as 
conscious  visual  impressions  are  received. 

In  later  life  still  more  extensive  tracts  become  medullary. 
After  the  third  year  it  is  impossible  to  trace  this  increase  for  the 
reason  that  the  medullated  fibres  have  already  become  too  univer- 
sal. Nevertheless,  there  is  a  great  probability  that  this  additional 
development  of  medullated  fibres  continues  for  many  years,  and 
that  new  nerve-tracts  are  continually  developed  as  new  regions 
cff  the  cortex  are  brought  into  activity. 

Below  the  cortex  lies  the  white  substance  of  the  hemi- 
spheres. The  homogeneous  white  mass  which  is  revealed  by  a 
section  through  the  centrum  semiovale  is  resolved  by  the  micro- 
scope into  a  great  number  of  fibres  crossing  each  other  in  every 
direction,  and  defying  our  attempts  to  differentiate  them.  Let 
us  endeavor  to  ascertain  what  is  at  present  known  about  these 
white  fibres. 

If  we  make  a  section  through  the  fresh  brain  of  a  newborn 
child  we  shall  see  that  below  the  cortex  there  lies  almost  every- 
where a  peculiar,  glistening,  reddish-gray  mass,  in  which  at  only 
one  point — underneath  the  posterior  central  convolution  and  its 
vicinity — medullary  fibres  can  be  found.  It  is  only  in  the  course 
of  the  first  months  of  the  post-natal  period  that  other  nerve- 
tracts  become  invested  with  medullary  substance.  This  takes 
place  first  in  those  bundles  of  fibres  which  pass  downward  from 
the  cortex,  afterward  in  those  which  connect  the  different  regions 
of  the  cortex  with  each  other.  The  latter,  the  fibrse  proprise 
of  the  cortex,  are  especiall)^  abundant  in  the  adult  brain.  They 
extend  everywhere,  from  convolution  to  convolution,  connecting* 
parts  which  lie  near  each  other  as  well  as  those  which  are  widely 


THE    CORTEX    OF    THE    FORE-BRAIN,    ETC.  69 

separated.  They  connect  whole  lobes  with  one  another.  Appar- 
ently these  "association-fibres  "  are  developed  when  two  different 
rejrions  of  the  cortex  are  associated  in  a  common  action,  or  thev 
are  developed  into  medullary  fibres  from  among  the  surrounding 
mass  of  indifferent  bundles  when  they  are  brought  into  more 
continuous  use  than  the  latter.  The  association-fibres  lie,  in 
great  part,  close  under  the  cortex;  some  of  them  also  lie  partly 
in  the  white  substance  of  the  hemispheres.  This  system  of  fibres 
is,  as  you  see,  especially  adapted  to  bring  all  parts  of  the  brain 
into  communication  with  each  other.  The  manifold  processes 
of  association  which  are  indispensable  to  thought,  motion,  and 
sensation  possibly  have  their  anatomical  substratum  in  these 
elements  of  the  brain.  It  is  not 
improbable  that  these  fibres  play 
an  important  part  in  generalizing 
the  movements  of  epileptic  seizures. 
It  is  possible,  in  animals,  to 
produce  contractions  of  the  asso- 
ciated muscles  by  irritating  certain 
regions  of  the  cortex,  and,  by  in- 
creasing the   irritation,  to  produce  fig.  39. 

^  '^  Diagram  of  tlie  flbrae  propriae  of  the 

convulsions   of  the  wliole  affected  cortex. 

side.  The  order  of  these  convulsions  corresponds  to  the  ar- 
rangement of  the  affected  centres  in  the  cortex.  As  this  irri- 
tation extends  it  never  skips  a  neighboring  motor  centre. 
The  convulsions,  when  they  have  affected  one-half  of  the  body, 
pass  over  to  the  other  half  "(nnder  certain  conditions,  'intensity 
of  the  irritation,  dis])osition  of  the  animal  experimented  on, 
etc.).  Removal  of  single  motor  centres  from  the  cortex  causes 
the  muscles  directly  controlled  by  them  to  be  omitted  from  the 
general  convulsive  seizure.  It  is  not  neces.sary  that  the  point 
of  cortex  so  irriUitod  shovdd  belong  to  the  motor  region.  The 
coinulsions  thus  brought  about  show  the  greatest  gihalogy  to 
a  partial  or  general  epileptic  att<ack  in  human  beings.  Since 
the  writings  of  Ilughlings-Jackson,  we  are  acquainted  with  forms 


70  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

of  epilepsy  which  begin  with  contractions  or  convulsions  in  one 
limb  and  spread  to  other  members,  or  over  the  whole  body ;  in 
the  latter  instance  presenting  a  typical  picture  of  an  epileptic 
seizure.  Consciousness  does  not  always  disappear  so  long  as 
the  attack  remains  partial.  After  the  attack  there  sometimes 
remain  paralyses,  which  are  generally  confined  to  the  regions 
first  attacked.  This  partial  or  cortical  epilepsy  cannot  be  differ- 
entiated from  the  classical  epilepsy.     The  latter  is  apparently 


Fig.  40. 
Diagrammatic  representation  of  a  part  of  the  association  fibres  of  one  hemisphere. 

only  a  form  in  which  the  initial  symptoms  succeed  each  other 
with  greater  rapidity. 

It  is,  however,  not  necessary  that  an  irritation  should  spread 
from  a  given  point  over  the  rest  of  the  brain  by  way  of  the  fibrae 
propriae.  There  are  many  other  ways  offered  by  which  this 
might  be  accomplished.  For  instance,  through  the  fine  net- 
work of  nerve-fibres  on  the  surface  of  the  brain ;  then,  too,  the 
whole  cÄtex  may  be  influenced  by  fluctuation  in  the  blood- 
pressure,  and  many  other  ways  might  be  thought  of 

It  is  not  very  difficult  to  trace  the  course  of  the  fibrae  pro- 


THE   CORTEX    OF    THE   FORE-BRAIN,    ETC. 


71 


prise  between  two  neighboring  regions  of  the  cortex  by  teasing. 
The  representation  of  the  connections  existing  between  more 
widely  separated  regions  is  much  more  difficult,  and  the  figures 
must  be  at  least  partly  diagrammatic,  not  representing  the  actual 
course  of  fibres.  A  few  bundles  only  can  be  easily  discerned. 
Such  are  the  fasciculus  uncinatus,  the  fasciculus  arcuatus,  the 
fasciculus  longitudinalis  inferior,  the  cingulum,  and  a  few  more. 
You  may  see  the  course  of  these  bundles  in  tlie  accompanying 
diagram.  Among  these  larger  association-bundles  there  are  few 
that  contain  very  long  fibres.  They  consist  rather  of  numerous 
shorter  fibres,  wliich  run  in  the  same  direction,  each  covering  a 
certain  part  of  the  whole  dis- 
tance to  be  traveled.  These  fibres, 
which  connect  the  different  parts 
of  one  hemisphere  with  each 
other,  are  mixed  with  fibres  which 
connect  the  corresponding  por- 
tions of  the  two  opposite  hemi- 
spheres. These  latter  fibres  run 
almost  exclusively  in  the  corpus 
callosum  and  the  anterior  com- 
missure, thus  passing  transversely 
through  both  hemispheres,  from 
one  to  the  other. 

Inasmuch  as  you  are  probably  acquainted  with  the  general 
macroscopic  appearance  of  the  corpus  callosum,  at  least  that 
portion  of  it  which  is  distinct  from  other  parts  of  the  brain,  I 
shall  have  only  a  few  words  to  say  concerning  the  accompanying 
Fig.  41. 

You  must  keep  in  mind  that,  just  as  you  see  the  fibres 
passing  from  side  to  side  in  this  section,  which  is  made  about 
transversely  through  the  chiasm,  so  they  are  to  be  seen  in  the 
whole  region  of  the  brain  over  the  lateral  ventricles.  Fibres 
also  pass  into  the  corpus  callosum  from  the  anterior  and  pos- 
terior regions.     The  course  of  the  fibres  of  the  corpus  callosum, 


Fig.  41. 

Frontal  section  through  the  fore-brain. 
Diagram  of  the  course  of  the  corpus  cal- 
losum and  the  anterior  commissure. 


72  LECTURES   ON    THE    CENTRAL    NERVOUS    SYSTEM. 

which  can  be  plainly  seen  on  the  median  surface  of  the  brain, 
is  shown  in  Fig.  42,  with  the  help  of  which  you  will  easily  be 
able  to  form  a  general  idea  of  the  distribution  of  the  fibres  of 
this  body.  Only  the  fasciculus,  called  the  tape  tum,  does  not 
belong  to  the  corpus  callosum,  as  was  formerly  thought.  It  is 
present  in  cases  where  the  corpus  callosum  is  wanting  (Kauf- 
mann, Onufrowics).  In  those  cases  it  is  apparent  that  it  is  the 
caudal  radiation  of  the  fasciculus  arena tus. 

Near  the  floor  of  the  third  ventricle  a  second  mass  of  fibres 
passes  transversely  across  in  front  of  the  anterior  ventricular  wall 
and  the  crura  of  the  fornix.  This  is  the  anterior  commissure. 
It  cannot  be  traced  on  a  cross-section,  as  is  sho^yn  in  the  partly 
diagrammatic  Fig.  41.  Its  fibres  are  much  more  curved,  inas- 
much as  they  pass  arch-like  through  the  corpus  callosum  on  each 
side,  curvhig  downward  and  backward,  and  are  lost  in  the 
white  substance  of  the  temporal  lobe.  In  Fig.  46  this  arch  has 
been  cut  through,  on  botli  sides,  external  to  and  below  the  nu- 
cleus lentiformis.  A  part  of  the  anterior  commissure,  which  is 
only  slightly  developed  in  human  beings,  but  strongly^eveloped 
in  lower  animals,  connects  the  two  points  of  origin  of  the  olfac- 
tory nerves  (olfactory-lobe  division  of  the  anterior  commissure). 
It  is  the  little  biuidle  which  passes  downward  into  the  gray 
matter  in  Fig.  41. 

From  every  part  of  the  cerebral  cortex  numerous  fibres 
arise,  which  connect  the  cortex  with  the  deeper-lying  portions 
of  the  central  nervous  system.  Very  many  pass  into  the  thala- 
mus, others  may  be  traced  to  the  gray  masses  of  the  mid-brain 
and  to  the  nerve-nuclei  of  the  pons,  in  which  they  seem  to  ter- 
minate. A  number  pass  farther  back  through  the  capsule,  the 
crus  cerebri,  the  pons,  and  the  medulla  oblongata  to  the  spinal 
cord,  where  they  enter  the  gray  matter  at  diff'erent  levels. 

Taken  together,  these  fibres  which  pass  downward  from 
the  cortex  are  called  the  corona  radiata.  You  will  form  no  bad 
idea  of  these  if  you  can  imagine  the  thalamus  placed  free  under 
the  overarching  dome  of  the  cortex,  and  then  assume  that  fibres 


THE  CORTEX  OF  THE  FORE-BRAIN,  ETC. 


73 


pass  from  every  part  of  the  latter  to  terminate  in  the  former. 
Bundles  of  fibres  pass  to  it  from  the  temporal  and  occipital,  the 
frontal  and  parietal  lobes.  Perhaps,  also,  bundles  from  the 
cortex  at  the  entrance  to  the  fossa  of  Sylvius  and  from  the  cornu 

Ccl4 


Bdf 


Baf 


0«ft 


Fig.  42. 

Posterior  portion  of  right  hemisphere,  internal  surface.  By  teasing  <>nt  with  forceps 
the  fibres  of  the  jjosterior  extremity  of  the  corpus  «tallosum  (splenium  Cci')  is  shown. 
The  round  nia.ss  under  the  corjjus  io"llosuni  is  tlie  thalamus  opticus,  Thu.  From  tlie  wall 
of  the  Hurrounfling  ventricle  the  tapetum,  7'ap,  passes  to  the  corpus  callosuni.  In  the 
«;ut  too.  is  shown  a  portion  of  the  fasciculus  loiiRitudinalis  inferior,  Fli.  Beneath  the 
thaianins  is  tlie  crusta,  Ji.  The  other  letters  refer  to  parts  whicli  will  be  explained  in  the 
t«;xt  later  on.  Jid/,  Vieq  d'Azyr'.s  bundle;  Ka/,  fornix;  Ccu,  corpus  candicans ;  //', 
optic  nerve.  The  bundle  of  (ibies  called  the  forceps,  J<'cp,  belongs  to  the  radiation  of  the 
corpus  callosuni.     (After  Henle. ) 

ammonis  (ruiiiiin^  tlicir  course  in  the  fornix).  A  part  of  the 
bundles  of  the  corona  radiata,  however,  do  not  go  to  the  thala- 
mus, but  pass  in  front  to  the  outside  and  back  of  it,  to  termina- 
tions which  li(,'  deeper. 


74 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


The  corona  radiata,  therefore,  consists  of  fibres  which  pass 
to  the  thalamus,  and  of  fibres  which  pass  to  deeper  regions. 

Fibres  pass  to  the  thalamus  from  almost  all  the  surface  of 
the  cortex,  and  not  in  a  few  bundles  merely,  as  is  shown  in  the 
following  diagram.  They  unite  near  the  thalamus  to  form  thick 
strands,  which  are  called  the  pedicles  (stilus)  of  the  thalamus. 
Among  fibres  passing  farther  caudad  are: — 
1.  Fibres  from  the  cortex  of  the  central  convolutions  and  the 
paracentral  lobule ;  that  is,  from  the  motor  region  of  the  brain  to 
the  nuclei  of  the  motor  nerves  in  the  brain  and  the  spinal  cord 

(pyramidal  tract). 

2.  The  speech-tract, 
to  the  nuclei  of  the 
nerves  in  the  oblongata 
which  have  to  do  with 
speech.  Its  origin  in  the 
cortex  of  the  third  frontal 
convolution,  its  course 
through  the  white  sub- 
stance to  the  outside  of 
the   tail  of  the   nucleus 


caudatus,  and  its  termi- 


FlG.  43. 
Diagram  of  the  fibres  of  the  corona  radiata,  espe- 
cially the  coronal  fibres  to  the  thalamus,     u.s.,  inferior  .  .  ,  .,    . 

pedicle.  uatioii     HI     the     nuclci 

Sehhügel,  Thalamus. 

above  mentioned,  have 
all  been  inferred  from  carefully-observed  clinical  cases,  verified 
by  autopsies.  It  has  not  yet  been  actually  demonstrated  by 
dissection.  The  speech-tract  in  passing  over  the  anterior  portion 
of  the  nucleus  lentiformis  lies  very  near  the  central  hypoglossal 
tract. 

3.  Bundles  from  the  cortex  of  the  frontal  lobe  to  the  pons 
or,  rather,  to  its  ganglion-cells  (anterior  cortical  tract  to  the  pons). 
They  pass,  in  all  probability,  from  the  pons  into  the  cerebellum. 

4.  Bundles  from  the  cortex  of  the  occipital  and  temporal 
lobes,  also  ending,  apparently,  in  the  ganglion-cells  of  the  pons 
(posterior  cortical  tract  to  the  pons). 


THE   CORTEX    OF    THE   FORE-BRAIN,    ETC.  75 

5.  Bundles  run  from  tlie  cortex  of  the  superior  parietal 
lobe  (and  the  posterior  central  convolution  1)  and  perhaps,  also, 
from  more  posterior  cortical  regions,  to  the  internal  capsule,  and 
in  part  pass  under  the  thalamus  to  the  spinal  cord,  and  partly 
enter  the  lenticular  nucleus.  They  pass  through  both  inner 
divisions  of  the  latter,  and  become  united  near  the  base  of  the 
brain  to  form  a  thick  strand,  whose  course  we  shall  have  occasion 
to  study  later  on  (tegmental  radiation).  These  latter  are  the 
first  cerebral  fibres  to  receive  their  investment  of  medullary 
sheaths.  They  alone  at  the  eighth  to  ninth  foetal  month  may 
be  recognized  as  a  thin,  white  bundle  in  the  internal  capsule, 
which  latter,  at  this  period,  appears  gray. 

6.  Fibres  pass  from  the  occipital  lobe  to  the  points  of  origin 
of  the  optic  nerve.  They  connect  the  real  optic  nucleus  with 
the  cortex.  In  Fig.  44  this  optic  radiation  is  shown  in  a  hori- 
zontal section  of  the  brain  of  a  nine-week-old  child. 

Its  destruction  in  human  beings  leads  to  disturbances  of 
vision,  which  will  be  described  later  on.  In  animals  it  does  not 
appear  to  be  so  important,  for  in  them  the  occipital  cortex  can 
be  destroyed  on  both  sides  without  producing  blindness.  The 
actual  centres  for  the  sense  of  sight  lie  deeper;  sight  continues 
if  only  they  are  preserved  intact,  but  it  is  diminished  to  a  certain 
extent  if  the  connection  between  these  lower  centres  and  the 
cortex  is  destroyed.  This  connection,  which  evidently  subserves 
some  psychic  process,  is  most  important  in  human  beings;  it  is 
apparently  less  so  in  the  other  mammals.  In  the  lower  animals, 
fishes,  for  instance,  it  is  altogether  wanting.  These  latter  see, 
at  least  in  the  case  of  teleostians,  without  anything  more  than  a 
thin,  epithelial  vesicle  in  place  of  a  cerebrum. 

Doubtless  there  are  a  great  number  of  other  systems  in  the 
corona  radiatii.  Observations  bearing  on  this  point  must  be 
undertaken  on  the  brains  of  very  young  children.  The  fibres 
receive  their  medullary  investment  at  difierent  periods,  and,  so. 
far  as  we  know,  the  whole  corona  radiata  is  medullary  at  the 
end  of  the  second  year. 


76 


LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 


On  their  passage  downward,  the  fibres  of  the  corona  radiata 
enter  into  important  relations  with  the  corpus  striatum  and  the 
optic  thalamus. 

They  naturally  converge,  and  so  reach  the  space  outside 
the  thalamus.  The  fibres  from  the  anterior  portion  of  the  brain 
must,  in  order  to  reach  this  point,  pass  through   the   corpus 


Fig.  44. 
Horizontal  section  tlirough  tlie  brain,  trending  downward  on  each  side. 

Balken,  Corpus  callosura.  Opticus  Strahlung,  Optio  radiation. 

striatum.     Tliis  is  made  clear  in  the  accompanying  horizontal 
section  through  the  cerebrum. 

This  section  is  made  about  a  finger's  breadth  lower  down 
than  the  one  shown  in  Fig.  19.  You  must  understand  that  the 
two  hemispheres  have  been  partly  removed,  and  that  their  coronal 
.  fibres  pass  from  above  downward  tlirough  the  knee-shaped  white 
line  of  the  inner  capsule.  That  portion  of  the  capsule  which 
comes  from  the  frontal  and  occipital  lobes  lies  partly  in  the  plane 


THE    CORTEX    OF    THE    FORE-BRAIN,    ETC. 


77 


of  this  section.  A  few  words  now  in  explanation  of  this 
figure. 

You  will  at  once  recognize  the  frontal,  occipital,  and  tem- 
poral lobes.  The  latter  is  placed  over  the  island  of  Eeil  and  in 
part  covers  it.  As  in  Fig.  19,  you  see,  in  front,  the  transversely 
divided  corpus  callosum,  the  septum  pellucidum  adjoining,  and, 
at  the  posterior  termination  of  the  latter,  the  ascending  pillars 
of  the  fornix. 

Anterior  and  external  to  the  septum  is  the  head  of  the 
nucleus  caudatus,  which,  in  this  section,  has  been  cut  into.  Its 
tail,  which,  in  Fig.  19,  passes  along  the  side  of  the  thalamus. 


Fig.  45. 
Nucleus  caudatus  dissected  out  along  its  wliole  length.     (Diagrammatic.) 

Ammmuhom.  Cornu  ammonis.  Riechlappen,  Olfactory'  lobe.  Vtuliihel,  Ventricle. 

can  no  longer  be  seen.  It  lies  in  the  part  of  the  brain  which 
has  been  removed.  A  small  portion  of  it  only  is  left,  pos- 
teriorly and  exteriorly,  near  the  cornu  ammonis.  The  above 
cut,  which  represents  a  nucleus  caudatus  dissected  out,  shows 
how  this  condition  is  brought  about. 

The  tail  of  the  nucleus  caudatus  is  b(Mit  in  a  curve  around 
the  whole  brain-axis,  and  can  be  traced  almost  to  the  apex  of 
the  inferior  horn  of  the  lateral  ventricle.  The  wliolc  nucleus, 
therefore,  must  appear  twice  on  any  deep  horizontal  section  of 
the  brain,  as  is  shown  by  the  line  a  to  b,  in  Fig.  45. 

Outside  the  head  of  the  nucleus  caudatus  we  see  some 


78 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


thick  masses  of  white  fibres.  They  come  from  the  frontal  lobe, 
and  contain  the  corresponding  portions  of  the  coronal  fibres  to 
the  thalamus  (thalamic  radiations)  and  the  anterior  cortical  tract 
to  the  pons.  These  fibres  must,  as  you  see  in  the  cut,  in  order 
to  reach  the  thalamus  and  the  pons,  pass  through  the  interposed 
corpus  striatum.     The  part  which    remains   lying  nearer  the 


Fig.  46. 
Frontal  section  through  the  fore-hrain  just  back  of  the  ascending  pillars  of  the  fornix. 

Balken,  Corpus  calloBum.  Marklager,  White  substance. 

median  line  is  the  nucleus  caudatus ;  the  external  part  is  the 
nucleus  lenticularis.  The  two  are  not  absolutely  and  totally 
divided  by  these  frontal-lobe  fibres ;  on  the  contrary,  numerous 
connecting  fibres  pass  between  them.  The  above-named  thala- 
mic radiations,  the  anterior  cortical  tract  to  the  pons,  the  bun-' 
dies  passing  between  the  head  of  the  nucleus  caudatus  and  the 


THE   CORTEX    OF   THE   FORE-BRAIN,    ETC.  79 

lenticular  nucleus,  and,  lastly,  fibres  from  the  nucleus  caudatus 
to  the  inner  divisions  of  the  lenticular  nucleus,  all  go  to  make 
up  the  internal  capsule, — the  white  mass  of  fibres  shown  in  the 
liorizontal  section. 

Fig.  46  is  intended  to  complete  the  picture  of  those  parts 
<>iven  in  the  horizontal  section.  It  strikes  the  ganglia  of  the 
corpus  striatum  far  forward,  and  clearly  shows  the  manner  of 
tlieir  separation  by  the  interposed  fibres  of  tlie  internal  capsule. 

The  form  and  situation  of  the  nucleus  caudatus  will  now 
be  clear  to  you,  but  it  will  be  more  difficult  to  form  an  idea  of 
the  peculiar  wedge-shaped  figure  of  the  lenticular  nucleus.  A 
study  of  the  horizontal  and  of  the  vertical  sections  shown  in 
Fig.  46  will  materially  aid  you.  This  ganglion  is  intimately 
associated  internally  with  two  somewhat  lighter,  grayish  gan- 
glionic masses,  which  are  closely  connected  to  it  by  nerve-fibres. 
AVe  speak  ordinarily  of  the  three  divisions  of  the  lenticular 
nucleus,  whereas  it  is  probable  that  only  one — the  broad,  dark, 
outer  portion  (the  putamen) — is  morphologically  analogous  to 
the  nucleus  caudatus.  The  latter,  as  above  stated,  sends  its 
fibres  through  the  anterior  branch  of  the  internal  capsule  to  the 
two  inner  divisions  of  the  lenticular  nucleus,  and,  perhaps, 
through  them  and  farther  caudad.  The  fibres  of  the  putamen 
nm  an  exactly  similar  course.* 

In  all  vertebrates,  from  fishes  up  to  birds,  a  thick  bundle 
of  fibres  can  b(,'  seen,  arising  in  the  corpus  striatum  and  ending 
partly  in  a  thalamic  nucleus  and  partly  passing  farther  back. 
It  can  only  be  found  with  difllculty  in  human  beings,  because 
too  many  bundles  from  the  cortex  are  united  with  it.  Still,  I 
have  recogiiiz(.'d  tliis  l)asal  fore-brain  bundle  in  early  embryos, 
and  it  is  api)arently  these  fibres  which  Wernicke  and  Flechsig 
have  described  as  springing  from  the  corpus  striatum.  The 
latter,  indeed,  recognized  their  connection  with  the  thalamus, 

•Thf!  flbrPH  arJHini;  in  the  ganglia  of  the  corpu«  striatum  receive  tlieir  iiiediillary  slieaths 
at  a  much  later  period  tlian  th(;  tegmental  radiation  which  i)asM»;H  through  the  inner  divisions 
of  the  nucleus  lentifnrmis.  Hence,  we  have  nucceeded  in  distinguishing  these  twosetsof  fibres, 
which  are  closely  intermingled  in  the  adult. 


80 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


External  to  the  corpus  striatum  lies  the  cortex  of  the  island 
of  Reil.  In  the  narrow  band  of  white  substance  which  lies  be- 
tween the  ganglion  and  the  cortex — that  is  to  say,  in  the  exter- 
nal capsule — is  placed  an  elongated  collection  of  ganglion-cells, 
— the  claustrum, — which  is  anatomically  somewhat  diiferent 
from  the  neighboring  cortex. 

Caudad  of  the  nucleus  caudatus  the  horizontal  section 
(Fig.  44)  passes  tlirough  the  thalamus, — the  inter-brain.  In 
front  of  this  the  pillars  of  the  fornix  ascend  from  below ;  the 


Fig.  47. 

Diagram  of  the  internal  capsule.    The  situation  of  most  of  the  tracts  of  fibres  which 

compose  it  is  indicated  by  the  names. 

Extremitäten  mot.  Bahn,  Motor  tract  to  the  extremities. 
Fasern  aus  Nucleus  Caudatus,  Fibres  from  nucleus  caudatus. 
Fasern  aus  N.  leiiti/ormi-s.  Fibres  from  nucleus  leutiformis. 
Frontale  Brückenhahn,  Anterior  cortical  tract  to  the  pons. 
'•  Opticus/asern,  Optic  fibres.  Sensoriaclie  Fasern,  Sensory  fibres. 

Stabkranz  zum  Thalamus,  Coronal  fibres  to  the  thalamus. 
Temporo-occipitale  Brückenbahn,  Posterior  cortical  tract  to  the  pons. 

commissura  media,  a  thin  band  of  gray  matter,  extends  from 
one  thalamus  to  the  other.  External  to  the  thalamus  passes  the 
posterior  branch  of  the  internal  capsule.  The  point  where  the 
two  branches  meet  is  called  the  knee  (genu).  Impress  this 
peculiar  angular  form  of  the  inner  capsule  well  upon  your 
memory.  The  relation  of  the  different  coronal  bundles  to  the 
two  angles  is  particularly  important  and  very  nearly  constant. 
In  the  posterior  branch,  not  far  from  the  knee,  lie  the  fibres 
from  the  motor  zone  to  the  extremities  (pyramidal  tract);  just 


THE    CORTEX    OF    THE    FORE-BRAIN,    ETC.  81 

in  front  of  them  are  situated  bundles  which  connect  with  the 
nuclei  of  the  facialis  and  hypogiossus,  and  have  their  origin  in 
the  lower  portion  of  the  anterior  central  convolution. 

Behind  the  pyramidal  tract,  near  the  last  third  of  the  pos- 
terior branch,  or,  perhaps,  somewhat  more  anteriorly,  Ave  meet 
with  the  bundles  known  as  the  tegmental  radiation,  and  back 
of  and  adjoining  them  the  tract  from  the  occipital  lobe  to  the 
origin  of  the  optic  nerve.  Judging  from  clinical  facts  there 
must  be  in  this  region  fibres  passing  from  the  temporal  lobes  to 
the  auditory  nuclei,  and  others,  also,  which  are  related  in  some 
way  to  the  sense  of  smell.  Thus,  in  the  terminal  third  of  the 
posterior  branch  of  the  internal  capsule  there  is  a  confluence 
of  all  the  sensory  fibres  and  of  the  fibres  to  the  nerves  of  special 
sense.  Besides  these,  moreover,  we  here  find  coronal  fibres  to 
the  thalamus  from  the  cortex  of  the  temporal  and  occipital  lobes, 
and  the  occipito-temporal  tract  to  the  pons.  The  preceding 
figure  gives  a  diagrammatic  view  of  the  separate  bundles  which 
compose  the  internal  capsule. 

Numerous  investigators  have  turned  their  attention  to  the  histology  of  the 
cortex  and  to  the  conditions  of  its  finer  structure.  However  great  the  labor  ex- 
pended in  this  field,  by  just  so  much  does  the  difficulty  of  the  problem  appear  to 
increase.  Newer  and  more  complicated  conditions  are  continually  being  dis- 
covered. Baillarger,  Bevan  Lewis,  Clarke,  Gerlach,  Meynert,  Golgi,  Bellonci, 
and  many  others  have  attempted  to  throw  light  upon  the  most  important  points. 
The  cortex  of  the  cornu  ammonis  in  particular  has  been  investigated  by  Kölliker, 
Henle,  and  Duval.  Many  facts  concerning  the  course  of  fibres  in  the  white- 
substance  of  the  hemispheres  were  discovered  by  F.  Arnold,  Reil,  and  Burdachu 
by  the  teasing  method  ;  while  the  microscopic  investigations  of  Meynert,  and 
more  particularly  the  embryological  studies  of  Flechsig,  and  the  numerous  ex- 
perimental works  of  Gudden,  Löwenthal,  Monakow,  and  many  others  have 
materially  advanced  our  knowledge  in  this  respect.  We  must  not  undervalue 
the  advantages  wliich  have  accrued  to  this  portion  of  brain  anatomy  from 
patliological  investigations.  Such  investigations  have  been  instituted  by  Wer- 
nicke, Charcot,  Fere,  Pitres,  Friedmann,  Sioli,  Monakow,  Richter,  and  others. 

All  the  masses  of  fibres  emerge  from  the  cortex  and  con- 
verge toward  the  region  external  to  the  thalamus.  A  portion 
of  them  enter  the  thalamus  (corona  radiata  of  the  thalamus) ; 
another  portion,  and  that  the  larger,  pass  under  the  thalamus 
to  terminate  in  ganglia  there  situated,  or  to  run  still  fartlier 

6 


82  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

caudad  to  the  spinal  cord.  Any  foci  of  disease,  therefore,  which 
are  situated  in  the  centrum  semiovale  must  involve  some  of  the 
coronal  fibres.  They,  however,  do  not  always  give  rise  to 
symptoms  which  would  lead  us  to  suspect  a  break  in  the  con- 
ductivity from  cortex  to  periphery.  This  may  be  because  the 
coarser  and  more  striking  lesion-symptoms,  the  only  ones  which 
can  be  detected  by  our  present  means  of  diagnosis,  require  for 
their  development  the  destruction  of  the  whole  tract  involved. 
Apparently  a  small  remnant  of  a  tract  suffices  to  conduct 
^^oluntary  impulses  from  the  cortex  to  deeper-lying  points,  and 
to  convey  sensory  impressions  from  the  periphery  to  the  cortex. 

Lesions,  in  particular,  which  do  not  lie  in  the  white  sub- 
stance under  the  central  convolutions — that  is  to  say,  lesions 
which  involve  the  tract  from  the  cortex  to  the  pons  and  the 
tegmental  radiation — often  give  rise  to  no  symptoms.  On  the 
other  hand,  lesions  which  involve  the  pyramidal  tracts  produce 
paralyses  of  the  opposite  half  of  the  body.  Disease  of  the 
white  substance  under  the  cortex  of  the  inferior  frontal  convo- 
lution often  leads  to  aphasia.  In  addition  to  these  there  are  a 
number  of  conditions  known  which  make  it  very  probable  that 
an  interruption  of  the  tegmental  radiation  may  bring  about  a 
loss  of  sensibility  in  one-half  of  the  body. 

It  is  pretty  well  established  that  diseases  which  involve  the 
region  just  back  of  the  knee  of  the  internal  capsule,  diseases,  at 
least,  which  render  the  fibres  incapable  of  conveying  nervous 
impulses,  suspend  the  motility  of  the  entire  opposite  half  of  the 
body,  and  that  lesions  situated  in  the  terminal  two-thirds  of  the 
posterior  branch  may  destroy  the  sensation  of  the  opposite  side 
of  the  body,  or  at  least  very  much  diminish  it.  In  most  cases  the 
sense  of  sight  also  suffers,  and  occasionally  the  sense  of  hearing. 
The  injury  to  the  sense  of  sight  takes  the  form  of  hemiopia. 

If  you  bear  in  mind  that,  as  has  been  repeatedly  stated,  all 
the  fibres  converge  radially  from  the  cortex  to  the  capsule,  you 
will  easily  understand  that  a  small  lesion  in  the  capsule  may 
give  rise  to  the  same  symptoms  which  would  be  produced  by  a 


THE    CORTEX    OF    THE'  FORE-BRAIN,    ETC. 


83 


larger  one  in  the  centrum  semiovale,  or  by  a  still  more  extensive 
one  in  the  cortex.  In  the  capsule  the  fibres  are  crowded  closely 
tojj^ether,  which,  higher  up,  are  spread  over  a  greater  surface. 
For  example,  a  great  extent  of  cortex  (both  central  convolutions 
and  the  adjoining  portions  of  the  frontal  and  parietal  convolu- 
tions) would  have  to  be  destroyed  in  order  to  produce  a  complete 
opposite  hemiplegia.  The  same  effect  might  be  caused  by  a 
smaller  lesion  in  the  centrum  semiovale  under  the  central  con- 
volutions, whereas  the  symptom-complex  in  question  could  be 
produced  by  a  very  small  lesion  in  the  posterior  branch  of  the 
inner  capsule.     In  cases  of  hemiplegia,  therefore,  we  at  once 


Cr  us  cerebri. 


Fig.  48. 


suspect  that  the  disease  is  located  in  the  neighborhood  of  or  in 
the  internal  capsule,  unless  additional  symptoms  point  directly  to 
some  other  region  of  the  brain.  Hemiplegias  from  disease 
of  the  cortex  are  very  rare.  Hemiplegias  arising  from  diseased 
foci  in  the  deeper-lying  portions  of  the  central  nervous  system 
are  still  rarer,  and  are  generally  associated  with  cranial-nerve 
symptoms,  whicli  indicate  the  scat  of  the  lesion. 

On  the  other  hand,  both  anatomical  considerations  and 
clinical  experience  teach  us  that  cerebral  diseases  which  affect 
single  members  of  the  body  (one  hand,  for  instance)  very  seldom 
have   their   seat   in   tlie  capsule,  because  the  fibres  there  are  so 


84  LECTURES   ON    THE  -CENTRAL    NERVOUS    SYSTEM. 

closely  crowded  together  that  a  focus  of  disease  could  scarcely 
involve  individual  fibres  without  affecting  others.  Disease  of 
the  cortex,  however,  not  infrequently  causes  monoplegias  and 
monospasms.  In  this  portion  of  the  brain  a  relatively  large 
area  may  be  involved  without  impinging  on  an  adjoining  centre. 
The  accompanying  diagram  will  effectually  impress  these  state- 
ments upon  your  mind.  It  shows  why  monoplegias  most 
frequently  have  a  cortical  origin,  whereas  hemiplegias  generally 
result  from  disease  of  the  deeper-lying  portions  of  the  brain. 
We  see  at  a  glance  that  a  lesion  of  a  given  extent,  situated  in 
the  cortex,  may  easily  affect  only  one  centre,  whereas  the  same 
focus,  more  deeply  situated,  might  affect  the  radiating  fibres  of 
many  centres. 

We  have  not  yet  learned  what  symptoms  would  arise  from 
involvement  of  the  association-fibres  alone,  because  these  fibres 
are  so  closely  blended  with  those  of  the  corona  radiata.  Pos- 
sibly certain  forms  of  disturbance  in  speaking,  reading,  and 
hearing  belong  in  this  category.  We  know,  too,  very  little  con- 
cerning the  symptoms  arising  from  destruction  of  the  corpus 
callosum.  It  appears  that  this  may,  under  certain  circumstances, 
be  entirely  destroyed  without  giving  rise  to  disturbances  of 
motility,  of  co-ordination,  of  sensibility,  of  the  reflexes,  or  of 
the  special  senses,  and  without  any  material  disturbance  of  the 
intellect.  One  case  of  disease  of  the  corpus  callosum  has  been 
observed  accompanied  by  an  uncertain  gait,  but  without  vertigo 
or  ataxia. 


LECTURE  VI. 

THE  CORONA  RADIATA,  THE  CORPUS  STRIATUM,  THE  THALAMUS,  AND 

THE  SUBTHALAMIC  REGION.   THE  STRUCTURES  AT  THE 

BASE  OF  THE  BRAIN. 

Gentlemen  :  As  you  saw  in  the  last  lecture,  a  great  part  of 
the  coronal  fibres  terminate  in  the  inter-brain,  in  the  optic  thala- 
mus. The  rest  pass  farther  caudad  and  ventrad  in  tlie  capsule. 
Thus  they  reach  the  region  back  of  the  thalamus  and  for  the 
most  part  lie  free  on  the  under  surface  of  the  brain.  This  thick 
bundle  of  white  fibres  emerging  from  the  base  of  the  brain  is 
called  the  foot  of  the  crus  cerebri,  pes  pedunculi,  or  crusta. 

As  you  see  in  the  accompanying  frontal  section,  this  free 
portion  of  the  capsule,  whose  fibres  curve  backward  in  the  crus 
cerebri,  lies  ventrad  of  the  thalamus.  Into  this,  the  pes  pedun- 
culi or  crusta,  pass  the  fibres  of  the  frontal  tract  to  the  pons, 
of  the  temporal  tract  to  the  pons,  and  of  the  pyramidal  tract. 
The  coronal  optic  fibres  and  the  tegmental  radiation  do  not 
enter  the  crusta.  Farther  back  under  the  corpora  quadrigemina, 
just  over  the  crusta,  in  the  same  relative  position  here  occupied 
by  the  thalamus,  He  the  fibres  wliich  spring  from  tlie  thalamus 
and  other  regions  of  the  brain,  and  the  fibres  of  the  tegmental 
radiation.  At  this  point  the  mass  of  fibres  from  the  fore-,  inter-, 
and  mid-  brains  are  divided  into  a  ventral  portion  (the  pes  or 
crusta)  and  a  dorsal  portion  (the  tegmentum).  First  let  us  turn 
our  attention  to  the  crusta.  The  accompanying  cut  (Fig.  50)  is 
an  endeavor  to  show  you  the  transition  of  the  internal  capsule 
into  the  pes  l)y  a  diagrammatic  horizontal  section.  The  thalamus 
is  rei)rescnted  as  transparent.  Posteriorly  the  section  tn^nds 
sharply  downward;  otherwise  it  would  not  show  the  crusta, 
which  is  situated  at  the  base  of  the  brain. 

(85) 


86 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


In  the  diagram  you  see  a  tract  descending  from  the  gangUa 
of  the  corpus  striatum.  It  Hes  above  the  tracts  from  the  cortex. 
In  all  probability  this  terminates  in  the  pons. 

The  relations  borne  by  the  fibres  from  the  ganglia  of  the 


Fig.  49. 

Frontal  section  through  the  fore-  and  inter-  brains  at  that  point  where  the  fibres  of  the 
internal  capsule  become  the  crusta. 


Balken,  Corpus  callosum. 


Hirnschenkel,  Pedune.  cerebri. 


Unlerhorn,  Inf.  horn. 


corpus  striatum  to  those  from  the  cortex  are  in  many  respects  still 
unknown.  The  foUowmg  are  the  most  important  points  which 
have  been  definitely  settled.  The  nucleus  lentiformis  consists 
of  an    outer    division  (the   putamen)  and  two   or  more  inner 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN. 


8T 


divisions  (the  globus  pallidus).  From  the  putamen  and  from  the 
nucleus  caudatus  übres  arise  which  pass  through  both  the  inner 
divisions  and  emerge  from  the  base  and  apex  of  the  nucleus 
lentiformis.  You  will  remember  from  the  second  lecture  that 
the  nucleus  caudatus  and  the  putamen  are  genetically  related  to 


Vorderer 
d.  Capsel. 


bt'jjihtppin . 


^u<L.Cii!iidai, 


,  'vKi^     V^  -  Thaiamuft . 


f  Schenkd 

11 


Himschetvkd . 


J^  rami  Je,  etc. 


,  )tfi\  'i<^iä\. 


»•*Uu/ 


Fig.  50. 

Diagram  of  the  course  of  fibres  from  the  internal  capsule  into  the  crusta.    (Modified 

from  Wernicke.) 


Btrnsrhenkrl,  Pedunc.  cerebri. 

Hint    Srlmnlcel   d.    Cap/iel,    Post,    branch    of 

capsule. 
Pyramide,  etc..  Pyramids,  etc. 


Stirnlappon,  Frontal  lobe. 

Vorderer  Schenkel  d.  Capsel,  Anterior  branch 

of  capsule. 
Zur  Brücke,  To  the  pons. 


the  cortex.     Now  you  see  that  they  also  give  off  fibres  just  as 
does  the  latter. 

Besides  these  fibres,  others  pass  from  the  cortex  to  the  len- 
ticular nucleus.  They  are  fibres  from  tlie  tegmental  radiation. 
These  emerge  from  the  internal  capsule  along  the  whole  inner 
border  (see  Fig.   51)  and    pass    into    the  two  inner  divisions. 


88 


LECTURES   ON    THE    CENTRAL    NERVOUS    SYSTEM. 


traverse  them,  just  as  do  the  fibres  from  the  nucleus  caudatus 
and  the  putamen,  and  again,  Uke  the  latter,  they  are  gathered  up 
into  a  thick  bundle  below  the  nucleus  lentiformis,  in  which  situ- 
ation they  are  called  the  ansa  lenticularis.  Most  of  the  fibres 
of  the  ansa  lenticularis,  after  passing  through  the  capsule,  extend 
to  the  region  below  the  thalamus,  called  the  regio  subthalamica. 
The  accompanying  cut  represents  a  section  through  the  brain 
of  an  eight  months'  foetus,  and  shows  the  relations  of  the  teg- 


FiG.  51. 

Frontal  section  through  the  brain  of  a  foetus  of  about  32  weeks.  All  the  medullary 
fibres  stained  black  by  haematoxylin.  The  tegmental  radiation  (above),  crusa  lenticu- 
laris (below),  and  anterior  commissure  (below  and  externally)  are  medullary.  There 
are  as  yet  no  medullary  fibres  in  the  putamen  or  nucleus  cauaatus. 

mental  tract  to  the  nucleus  lentiformis.  At  this  period  of  devel- 
opment there  are,  with  the  exception  of  those  shown  in  Fig.  51, 
no  medullary  fibres  in  the  brain.  The  fibres  which  arise  in  the 
putamen  and  the  nucleus  caudatus  have  not  yet  appeared.  It 
was  only  possible  to  gain  an  insight  into  the  relations  between 
the  nucleus  lentiformis  and  the  tegmental  radiation  by  studying 
the  foetal  brain. 

In  this  figure  the  bundle  which  passes  directly  from  the 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN.       89 

tegmental  tract  to  regions  farther  back  (dorsad  of  the  gray  mass 
marked  "  corpus  subthal.")  is  not  visible  because  it  does  not  fall 
within  the  plane  of  this  section.  Compare  the  line  in  Fig.  52, 
marked  "to  the  fillet,"  which  represents  the  course  of  this 
bundle.     Compare  also  Fig.  54. 

You  have  now,  gentlemen,  learned  the  origin  and  the  first 
part  of  the  course  of  a  good  share  of  those  fibres  which  go  to 
make  up  the  fore-brain.  Let  us  now  turn  our  attention  to  the 
region  where  a  majority  of  the  cerebral  medullary  tracts 
terminate. 

Back  of  the  hemispheres  comes  the  inter-brain.  From 
each  of  its  lateral  walls  have  developed  the  optic  thalami.  These 
consist  of  several  gray  nuclei,  which  are  not  sharply  divided  from 
one  another.  vSome  white  medullary  fibres,  the  stratum  zonale, 
pass  over  the  thalamus.  A  part  of  these  can  be  traced  in  a 
direction  toward  the  base  of  the  brain  in  the  optic  nerve,  while 
another  part  seems  to  originate  from  the  caudal  portion  of  the 
internal  capsule,  perhaps  from  the  optic  radiation.  All  of  them 
pass  deeply  into  the  thalamus  and  are  massed  together  between 
its  ganglia,  whicli  they  apparently  separate  from  one  another. 
Microscopic  examination  shows  that  they  enter  into  the  fine  net- 
work of  nerve-fibres  which  penetrates  these  ganglia.  We  can 
distinguisli  in  every  thalamus  a  median  (internal)'nucleus  which 
projects  into  the  ventricle,  becomes  thickened  posteriorly,  and 
forms  the  pulvinar,  a  lateral  or  external  nucleus,  and  between 
tlie  two  an  anterior  nucleus.  The  lateral  nucleus  is  the  largest, 
while  the  anterior  nucleus  may  be  compared  to  a  wedge  driven 
in  between  the  other  two  with  its  broad  end  to  the  front.  This 
anterior,  thickened  end,  which  is  visible  as  an  elevation  of  the 
surface  of  the  thalamus,  we  have  already  met  with  under  the 
name  of  tuberculum  anterius.  On  the  median  border  of  the 
internal  nucleus  lies  the  ganglion  habenula3,  which  has  been 
mentioned  b(?fore.  In  tlie  posterior  portion  of  the  thalamus 
below  and  external  to  the  pulvinar  lies  a  ganglion  of  a  peculiar 
grayish  appearance, — the  corpus  geniculatum  laterale;  it  projects 


90 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


far  into  the  substance  of  the  thalamus  and  gives  off  a  great 
many  roots  to  the  optic  tract. 

Externally,  the  thalamus  borders  on  the  internal  capsule 
(Fig.  52).     Numerous    bundles  pass  from  the  latter  into  the 


^'"poralis. 

Fig.  52. 

Frontal  section  through  the  brain  in  front  of  the  section  shown  in  Fig.  49,  just  behind 
the  chiasm.     (Diagrammatic.) 

CerUr.  Höhlengrau,  Central  (ventricular)  gray  StaOkranz  zum  Thalamus,  Coronal  tract  to  the 

matter.  thalamus. 

Gitter.ichicht,  Latticed  layer.  Unterer     Thalamus    SlieM,    Inf.    pedicle    of 

JBauhenfaserung,  Fibres  to  the  tegmentum.  thalamus. 

Lins.  K.  Schlinge,  Ansa  lenticularis.  Zur  Schleife,  To  the  fillet. 

former.  They  come  from  different  directions,  and  cross  each 
other  on  entering  the  thalamus.  In  this  net-work  of  decus- 
sating fibres  are  found  small  aggregations  of  gray  matter.  The 
outer  zone  of  these  crossed  fibres  is  called  the  latticed  layer. 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN.       91 

From  the  fart  that  the  majority  of  tlie  medullary  fibres  pass  into 
the  external  nucleus,  this  body  has  a  somewhat  lighter  appearance 
than  the  other  nuclei  of  the  thalamus. 

The  inner  surface  of  the  thalamus  is  separated  from  the 
ventricle  by  an  evenly  distributed  layer  oi'  gray  matter.  This 
is  called  the  central  gray  matter  of  the  middle  (third)  ventricle. 
In  the  median  line  of  the  brain  the  central  gray  matter  forms 
the  floor  of  the  ventricle.  Between  the  two  thalami  lies  the 
middle  commissure.  In  human  beings  it  consists  of  only  a  few 
ner\  e-fibres  passing  across  in  the  midst  of  a  large  mass  of  cen- 
tral gray  matter.  In  the  lower  animals  it  contains  a  relatively 
larger  number  of  medullary  fibres,  arising  in  the  central  gray 
matter  of  the  ventricles,  in  which  they  run  parallel  to  the  long 
axis  of  the  brain. 

In  the  following  highly  diagrammatic  figure  we  may  see  the 
relations  of  the  thalamus  to  the  base  of  the  brain,  to  the  central 
gray  matter,  to  the  internal  capsule,  and  to  the  nucleus  lenti- 
formis. 

Let  us  study  in  this  figure  a  subject  which  hitherto  has  only 
been  touched  upon.  I  refer  to  the  region  internal  to  the  len- 
ticular nucleus  and  ventrad  of  the  thalamus.  Here  are  to  be 
seen  several  bundles  of  fibres  running  parallel  with  each  other, 
which  in  part  cross  the  internal  capsule  at  an  angle  and  in  part 
pass  over  it.  ^he  upper  of  these  bundles  belongs  to  the  system 
of  fibres  of  the  lenticular  rwicleus;  it  is  the  previously-described 
ansa  lenticularis.  The  lower  bundles  are  coronal  fibres  to  tlie 
thalamus,  which,  coming  from  the  occipital  and  temporal  lobes, 
are  called  the  inferior  pedicle  of  the  tlialamus  (?(.,<?.,  Fig.  43). 
Taken  together  the  mass  of  fibres  shown  in  Fig.  52,  ventrad  of 
the  lenticular  nucleus,  is  called  the  substantia  innominata.  Just 
back  of  the  substantia  innominata  the  fibres  of  the  capsule, 
which  gr)  to  make  uj)  tlu^  crusta,  emerge  free  on  the  base  of  the 
brain.  The  substantia  innominata,  therefore,  bounds  the  pedun- 
culus  cerebri  anteriorly.  It  is  laid  like  a  loop  over  it,  and  is  on 
that  account  called  the  ansa  peduncularis. 


92 


LECTURES    ON    THE   CENTRAL    NERVOUS    SYSTEM. 


Back  of  and  underneath  the  thalamus  there  he  alongside 
it  a  number  of  small  nuclei  whose  functions  and  significance  are 
almost  wholly  unknown.  Their  anatomical  relations  are  as  yet 
in  great  measure  unexplored.  On  the  base  of  the  brain,  just 
back  of  the  plane  of  the  section  in  Fig.  52,  where  the  central 
gray  matter  forms  the  floor  of  the  ventricle,  there  lies,  on  each 
side  under  the  thalamus,  a  small,  white  tubercle, — the  corpus 
mamillare  or  corpus  candicans.  In  Fig.  49  it  falls  just  in  the 
plane  of  the  section.  The  mammillary  body  may  be  regarded  as 
the  boundary-point  between  the  fore-  and  inter-  brains,  for  from 


Fig.  53. 

Frontal  section  tlaroiigh  the  tlialamus  and  the  corpus  mamillare  to  show  a  portion  of  the 
fibres  originating  in  this  region.     (Diagrammatic.) 


Bindearm,  Anterior  cerebellar  peduncle. 


BaubenhUndel,  Fasciculus  to  tegmentum. 


it  appear  to  emerge,  partly  crossed  and  partly  direct,  those 
bundles  to  the  fornix  which  follow  along  the  free  border  of  the 
hemisphere,  and  whose  further  course  is  shown  in  Fig.  30. 

The  corpus  candicans  consists,  according  to  the  researches 
of  Gudden,  of  three  nuclei.  The  most  lateral  sends  a  pedicle 
(pedunculus  corporis  mamillaris)  far  back  into  the  medulla 
oblongata.  From  the  more  caudad  of  the  two  median  nuclei 
arises  a  thick  bundle,  which  passes  up  into  the  thalamus  and  is 
lost  in  the  tuberculum  anterius.  One  portion  of  its  course  is 
shown  in  Fig.  49.     It  was  formerly  thought  that  it  arose  in  the 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN.       93 

thalamus,  bent  around  in  the  corpus  candicans,  and  passed  hito 
the  fornix.  The  investigations  of  Gudden,  however,  have  dis- 
proved this;  therefore,  its  old  name,  fornix  descendens,  is  not 
justified,  and  it  is  now  called,  after  its  discoverer,  the  bundle  of 
Vicq  d'Azyr.*  Arising  from  the  more  anterior  of  the  nuclei, 
a  little  strand  of  fibres  ascends  toward  the  thalamus  alongside 
the  last-described  bundle,  but  soon  changes  its  course  and 
passes  backward,  curving  caudad  until  it  reaches  the  tegmentum 
back  of  the  region  of  the  corpora  quadrigemina,  where  it 
can  be  traced  into  ganglia  that  lie  under  the  aqueduct  of 
Sylvius.  This  is  called  the  tegmental  bundle  of  the  mam  miliary 
body. 

If  you  will  examine  Fig.  46  or  49  you  will  see  that  the 
thalamus  lies  directly  upon  the  internal  capsule.  Farther  back 
this  condition  of  things  ceases.  Here  several  small,  gray,  gan- 
glionic masses  are  interposed  between  the  capsule  and  the 
thalamus.  Into  these  ganglia  numerous  bundles  of  fibres  radiate 
from  the  nucleus  lentiformis,  the  capsule,  and  the  thalamus 
itself  The  posterior  basal  inter-brain  region  where  this  occurs 
is  called  the  regio  subthalamica.  The  regio  subthalamica  was 
first  accurately  known  through  the  researches  of  Luys  and 
Forel,  and  later  by  the  works  of  Flechsig  and  AVernicke.  We 
are,  however,  still  far  from  a  comprehension  of  the  complicated 
conditions  which  are  presented  to  us  in  this  little  space,  where 
fibres  of  such  widely  different  origin  meet,  interloop,  and  cross 
each  other,  and  where  gray  masses  lie  which  are  themselves  in 
part  permeated  by  a  fine-meshed  net-work  of  crossing  and  inter- 
mingling medullary  fibres. 

Fig.  54  shows  a  few  details  of  a  section  through  this 
region.  Below  the  thalamus  is  a  rounded  ganglion, — the  nucleus 
ruber,  the  red  nucleus  of  the  tegmentum.  External  to  it  lies 
the  lenticular-shaped  corpus  subthalamicum  (body  of  Luys). 
You  recollect  the  bundle  of  coronal  fibres  which  we  called  the 

•  Compare  Ki^.  42,  wliere  by  diHHCCtion  a  perceptible  loop  is  brought  into  view  between 
the  two  portion»  of  the  fornix  in  the  corpus  candicans. 


94 


LECTURES   ON    THE    CENTRAL   NERVOUS    SYSTEM. 


tegmental  radiation.  Its  fibres  pass  out  of  the  internal  capsule, 
and,  to  a  great  extent,  lie  outside  of  and  above  the  red  nucleus, 
surrounding  about  a  third  of  that  ganglion  like  a  capsule ;  pass- 
ing back  of  the  red  nucleus  they  form  a  tract  of  fibres  which 
we  shall  learn  to  know  as  the  lemniscus,  laqueus,  or  fillet.  In 
Fig.  52  the  course  of  these  fibres  is  shown  in  diagram.     At  the 


Fig.  54. 

Subthalamic   region  of  a  4-week-old  child.    Frontal  section.    Compare  Fig.  51,  where 
only  the  tegmental  tract  is  clearly  visible. 


tip  of  the  lenticular  nucleus  the  fibres  from  its  different  divisions 
and  from  the  ansa  lenticularis  unite  to  form  a  thick  bundle. 
This  passes  through  the  capsule  (Fig.  52)  in  numerous  fasciculi 
and  enters  into  a  net- work  which  closely  surrounds  the  corpus 
subthalamicum.  From  this  net-work  most  of  these  fibres  pass 
into  the  ganglion  itself;  a  few,  however  (but  of  this  I  am  not 
firmly  convinced),  pass  directly  from  the  nucleus  lentiformis  to 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN.       95 

the  tract  called  the  fillet  without  entering  into  any  relation  with 
the  interior  of  the  corpus  subthalamicum. 

Fibres  from  the  optic  thalamus  run  to  the  red  nucleus. 
Posterior  to  the  accompanying  figure  the  latter  becomes  much 
larger,  so  that  it  occupies  a  greater  area  in  cross-section  (Fig.  59). 
Posterior  to  and  below  the  corpus  subthalamicum,  just  over  the 
fibres  of  the  internal  capsule,  which  at  this  point  are  beginning 
to  form  the  pes  pedunculi,  there  is  situated  an  aggregation  of 
gray,  pigmented  cells  (the  substantia  nigra),  just  at  the  point 
where  the  corpus  subthalamicum  is  represented  in  Fig.  54. 
From  the  subthalamic  region  downward  to  the  termination  of 
the  mid-brain  this  dark,  ashen-gray  ganglion  is  always  demon- 
strable just  over  the  crusta. 

The  fibres  passing  backward  from  the  fore-  and  inter-  brains 
are  divided  by  the  substantia  nigra  into  two  portions,  corre- 
sponding to  their  physiological  significance, — the  crusta  and  the 
tegmentum.  The  former  we  have  already  considered  at  the 
beginning  of  this  lecture,  and  we  shall  often  have  occasion  to 
refer  to  it;  the  latter  contains,  in  the  posterior  thalamic  region, 
which  we  are  now  considering,  the  pulvinar,  the  nucleus  ruber, 
the  corpus  subthalamicum,  the  fibres  from  the  lenticular  nucleus 
and  that  ])art  of  the  tegmental  radiation  which  has  not  united 
with  the  fibres  of  the  lenticular  nucleus. 

We  are  now  to  consider  the  structures  which  appear  in  a 
transverse  section  made  at  a  point  in  Fig.  55  indicated  by  the 
line  a  to  h. 

You  see  that  just  back  of  it  the  mid-brain — the  corpora 
quadrigemina — begins.  The  thalami  at  this  point  become  sep- 
arated and  between  them  the  central  gray  matter  increases  some- 
what, and  the  middle  ventricle  thereby  becomes  much  more 
shallow. 

Behind  this  point  the  roof  of  the  brain-vesicles,  which,  in 
tlie  vicinity  of  the  thalamus,  consisted  only  of  the  epithelial 
covering  of  the  choroid  plexus,  once  more  becomes  distinct. 
The   ventricle  is  closed  above  by  a  roof  composed  of  nerve- 


96  LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 

substance,  which,  from  now  on,  is  not  lost  sight  of  until  we 
reach  the  spinal  cord. 

In  the  anterior  part  of  this  roof  are  situated  the  fibres  of 
the  posterior  commissure,  and  just  behind  these  are  the  corpora 
quadrigemina.  The  ventricle,  which  is  here  contracted  to  a 
narrow  passage,  extends  under  this  roof,  and  that  portion  of  it 
which  traverses  the  mid-brain  has  received  the  name  of  the 
aqueduct  of  Sylvius.  The  entrance  to  the  aqueduct  lies  just 
under  the  posterior  commissure.  It  is  entirely  surrounded  by 
the  central  gray  matter.  As  it  passes  over  the  after-brain  the 
canal  again  becomes  widened,  and  in  this  situation  is  called  the 
ventriculus  quartus.  Its  floor  is  formed  by  the  fossa  rhom- 
boidalis  and  its  roof  by  the  cerebellum. 

It  will  be  well  for  you  to  study  the  appearance  of  the  mid- 
brain roof,  verifying  the  foregoing  statements  on  the  sagittal 
section  (Fig.  56). 

Only  a  few  words  concerning  the  pineal  gland,  which,  with 
its  two  pedicles  running  along  the  inner  surfaces  of  the  thalami, 
forms  a  part  of  the  roof  of  the  inter-brain.  (See  Fig.  11.)  It 
consists  mainly  of  a  dense  mass  of  epithelial  tubules  which  have 
arisen  by  proliferation  from  the  primitive  fold.  The  pedicles — 
the  pedunculi  glandulae  pinealis — convey  a  few  medullary  nerve- 
fibres.  These  apparently  originate  in  the  ganglion  habenulae 
and  (as  may  be  demonstrated  in  all  the  lower  vertebrates)  in  the 
thalamus.  I  must  again  remind  you  of  what  was  said  in  the 
second  lecture  concerning  the  significance  of  the  pineal  gland 
in  reptiles.  Besides  the  tubules,  the  pineal  gland  contains  nu- 
merous blood-vessels  and  the  "brain-sand," — little  concretions 
of  a  laminated  structure,  which  consists  mainly  of  calcareous 
salts  and  a  small  amount  of  organic  matter. 

Fig.  55  will  show  you  the  situation  of  the  pineal  gland  at 
the  posterior  end  of  the  thalami  and  between  the  corpora  quad- 
rigemina. 

We  have  hitherto  had  no  opportunity  to  examine  carefully 
the  base  of  the  brain.     Now  that  the  source  of  some  of  the 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN. 


97 


structures  which  are  there  situated  is  known  to  us,  let  us  turn  a 
brain  bottom  upward,  and,  having  cleared  away  the  pia  mater 
and  blood-vessels,  study  the  specimen  carefully. 

The  figure  given  later  on  (page  99)  will  serve  as  a  guide. 
First,  w^e  see  the  crura  cerebri  emerging  from  the  mass  of  the 


Cercyjcuuf- 
Fio.  55. 
The  ventricle  opened  from  above. 

Untf.rhorn,  Inferior  horn. 


brain.  Just  in  front  of  them,  in  the  space  which,  in  the  cut,  is 
occupied  by  the  optic  nerve,  lies  the  substantia  innominata, 
which  conüiins  tlie  ansa  lenticularis  and  the  inferior  pedicle  of 
the  thalamus.  Previous  frontal  sections  liave  taught  you  that 
the  white  mass  visible  here  is  the  pes  ])edunculi,  which  is  the 


98 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


direct  continuation  of  the  internal  capsule.  After  passing  back- 
ward a  short  distance,  the  pedunculus  cerebri  is  covered  in  by  a 
thick  mass  of  fibres,  which  appear  to  run  transversely  across  it 
from  one-half  of  the  cerebellum  to  the  other.  These  are  called 
the  fibres  of  the  pons  (fibrae  pontis). 


rebella 


Ceidtal 
Kanal 


Fig.  56. 

Sagittal  section  tlirougli  the  inter-braiu  and  the  structures  lying  back  of  it,  exactly 
in  the  middle  -line.  The  course  of  many  fibres  of  the  corona  radiata  is  indicated  by 
lines. 

Central  Kanal,  Central  canal.  Pj/ramiden  Fasern,  Pyramidal  fibres. 

Haube,  Tegmentum.  PyramidenJcrevzxng,  Pyramidal  decussation. 

Haubenstrahlung,  Tegmental  radiation.  Zu  den  Opticuscentren,  To  the  optic  nuclei. 

Zur  Brücke,  To  the  pons. 

Below  the  pons  a  portion  of  the  fibres  of  the  peduncle 
again  comes  into  view,  forming  the  pyramids.  Another  portion 
of  the  peduncular  fibres  terminates  in  ganglia  which  are  located 
among  the  fibres  of  the  pons. 

The  gray  matter  between  the  crura  cerebri  is  called  the  sub- 
stantia perforata  posterior.     Internally,  it  borders  on  the  sub- 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN. 


99 


thalamic  region.  In  front  of  it  lie  the  niammillary  bodies,— those 
two  roundish  ganglia  which  we  studied  in  cross-section.  To 
these  ganglia  the  bundle  of  Yicq  d'Azyr  passes  from  the  thala- 


Fig.  57. 


The  base  of  the  brain.    The  left  temporal  lobe  represented  as  in  part  transoarent  in 
order  to  show  the  whole  extent  of  the  oi)tic  tract        "^"^P^'^''"*  '» 

mus,  and  from  them  tlio  ascending  fornix  appears  to  emerge. 
In  front  of  the  mammillary  bodies  we  find  a  bulging  down- 
ward of  the  floor  of  the  middle  ventricle,  which  is  called  the 


100  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

tuber  cinereum;  thus  a  funnel-shaped  body  is  formed,  the  lumeif 
of  which  is  a  continuation  of  the  ventricle.  At  the  lower, 
pointed  end  of  this  structure  (infundibulura)  the  hypophysis  is 
attached.* 

The  optic  tracts  pass  in  a  broad  curve  around  the  infun- 
dibulum  and  over  the  pedunculi  toward  the  pulvinar  of  the 
thalamus.  Covered  in  on  both  sides  by  the  temporal  lobes,  they 
curve  upward  and  outward  around  the  origin  of  the  pedunculi 
to  reach  the  corpus  geniculatum  laterale  and  the  pulvinar. 

Farther  forward  in  front  of  the  infundibulum  they  are 
united  and  form  the  chiasm  from  which,  after  the  decussation 
of  their  fibres,  tlie  optic  nerves  arise. 

In  front  of  the  optic  tract,  external  to  the  chiasm,  just 
under  the  anterior  part  of  the  corpus 
striatum,  lies  the  substantia  perforata 
anterior, — a  grayish  mass  penetrated 
by  numerous  blood-vessels  from  the 
pia.  In  front  of  it  is  the  region  of 
the  lobus  olfactorius. 
Fig.  5s.  The    olfactory    lobe,    in    many 

The  hypophysis  seen  from  behind.       auimals,  is  a  larg'e  omsuci  Oil  the  base 

(After  Schwalbe.)  '  &  ö 

of  the  fore-brain  ;  in  water  mammals 
it  is  entirely  wanting,  while  in  human  beings  and  apes  it  is 
very  much  atrophied. 

Its  anterior,  bulbous  extremity  is  called  the  bulbus  olfacto- 
rius, and  its  posterior  portion,  which  is  continuous  with  the 
cortex  of  the  frontal  lobe,  has  received  the  name  of  tuber 
olfactorium.  That  portion  which  lies  between  the  two  has  be- 
come atrophied  to  a  thin  pedicle, — the  tractus  olfactorius.     The 

*  The  hypophysis  (Fig.  58).  an  appendix  to  the  base  of  the  brain,  about  the  size  of  a 
cherry,  consists,  first,  of  a  prolongation  of  the  floor  of  the  ventricle  (lobus  infundibuli),  which  is 
not  positively  proved  to  consist  of  nerve-substance,  and,  secondly,  of  a  tuft  of  epithelial  tubules 
which  are  firmly  attached  to  the  lobus  infundibuli,  and  which,  as  you  know,  is  derived  from  the 
mucous  membrane  of  the  pharynx.  In  vertebrates  other  than  mammals  this  epithelial  portion 
of  the  hypophysis  is  not  attached  to  the  lobus  infundibuli  at  all.  Later  researches  (Flesch, 
Darkschewitsch)  have  shown  that  it  contains  two  forms  of  cells, — small  hyaline  and  large, 
granular,  nucleated  cells.  Inasmuch  as  very  similar  elements  are  found  in  several  very  active 
glands,  it  is  probable  that  the  hypophysis  has  some  physiological  function  to  perform. 


-    --y    Jnfandzhuliim. 

^^  Ip-Ksi^J  Hypophysis. 
-Loh  us  inftinaibuii. 


THE  STRUCTURES  AT  THE  BASE  OF  THE  BRAIN.      101 

cortex,  too,  which  covers  the  whole  lobe  is  atrophic  in  the 
olfactory  tract.  The  fibres  of  the  actual  olfactory  nerves  arise 
from  the  olfactory  bulb. 

The  olfactory-lobe  cortex  has  numerous  connections  with 
regions  of  the  brain  whicli  lie  farther  back.  Some  of  these  are 
plainly  visible  on  the  base  of  the  brain.  They  pass  over  the 
substantia  perforata,  and  in  part  penetrate  it.  Formerly  these 
weve  thought  to  be  real  nerve-roots,  but,  according  to  our  present 
"\iews,  it  is  much  more  probable  that  they  are  tracts  which  serve 
to  connect  the  olfactory  lobe  with  more  central  portions  of  the 
brain.  The  most  external  of  these  bundles  can  be  traced  into 
the  tip  of  the  temporal  lobe.  The  results  of  physiological  ex- 
periments make  it  probable  that  it  terminates  in  the  cornu 
amnion  is.  The  investigations  of  Zucke  rkandl  in  comparative 
anatomy  show  that  these  olfactory  nerve-roots  have  their  termi- 
nation not  only  in  the  cornu  ammonis,  but  probably  in  the 
cortex  of  the  whole  gyrus  hippocampi  and  the  lobus  lingualis, 
wliich  is  associated  with  it. 

In  the  olfactory  nerves  of  the  lower  animals  there  has  been 
demonstrated  an  extensive  system  of  commissures  and  a  chiasm 
between  them.  We  only  know  that  fibres  from  the  anterior 
commissure  pass  into  the  region  of  the  olfactory  lobe.  These 
fibres,  whicli  can  be  plainly  seen  in  Fig.  41,  form,  as  it  appears, 
a  commissure  between  the  olfactory  lobes.  The  other  fibres  of 
the  anterior  commissure  connect  the  two  lobi  linguales  (which 
are  also  points  of  origin  for  the  olfactory  nerve)  with  each 
other. 

The  gray  lamina  between  the  two  olfactory  lobes  is  directly 
continuous  in  front  with  the  knee  of  the  corpus  callosum.  It 
is  called  the  lamina  terminalis.  It  is  the  remnant  of  the  em- 
bryonic terminal  lamina, — that  wall  which  closed  the  primitive 
fore-brain,  and  from  wliich  the  massive  hemispheres  have  been 
developed.  At  present  it  is  only  a  small,  unimportant  gray 
area,  which  lies  at  the  most  anterior  point  of  the  base  of  the 
brain. 


102  LECTURES   ON    THE    CENTRAL   NERVOUS    SYSTEM. 

The  thalami  are  everywhere  in  such  close  juxtaposition  to  the  internal 
capsule  that  we  very  seldom  see  cases  of  disease  which  involve  them  alone. 
Even  in  these  cases  it  is  doubtful  to  what  extent  the  symptoms  present  depend 
upon  involvement  of  the  neighboring  fibres  of  the  internal  capsule.  It  is,  there- 
fore, impossible  to  determine  the  symptom-complex  presented  by  disease  of  the 
thalami.  According  to  Meynert  the  sensations  of  innervation  of  the  upper  ex- 
tremities are  injured.  As  a  result  we  would  have  delusions  as  to  the  position  of 
the  limb,  and,  in  consequence  of  these  delusions,  forced  attitudes  would  be 
assumed.  Neither  motor  nor  sensory  paralyses  seem  to  be  caused  by  injuries  to 
the  thalami.  Inj  nines  to  sight  in  the  form  of  homonymous,  lateral  hemianopia, 
and,  perhaps,  also  of  crossed  amblyopia,  have  been  repeatedly  observed.  In 
disease  of  the  thalamus  there  have  often  been  observed  symptoms  of  hemichorea, 
athetosis,  and  tremor  of  one  side  of  the  body.  These  last  symptoms,  however, 
have  also  been  observed  in  disease  of  other  parts  of  the  brain. 

The  same  obstacles  present  themselves  in  attempting  to 
define  the  symptoms  of  disease  in  the  corpus  striatum.  Those 
symptoms,  which  were  formerly  considered  as  indicating  disease 
at  this  point  (hemiplegia,  for  example),  may  equally  well  be 
caused  by  disease  of  the  neighboring  internal  capsule.  One 
case  of  disease  of  the  putamen  is  known  to  have  run  its  course 
without  giving  rise  to  symptoms  which  pointed  to  trouble  in 
that  locahty. 

If  an  affection  of  the  base  of  the  brain  only  involves  that 
part  which  lies  in  front  of  the  pons,  the  symptoms  caused  by 
the  irritation  or  paralysis  of  the  nerves  in  that  region  are  far 
more  important,  for  diagnostic  purposes,  than  anything  else. 
If  the  pedunculi  are  also  involved  there  may  be  associated  with 
these  symptoms  motor  and  sensory  disturbances  of  the  ex- 
tremities. A  careful  analysis  of  the  symptoms,  in  connection 
with  an  accurate  knowledge  of  the  anatomy  of  the  base  of  the 
brain,  often  leads  to  very  clear  and  exact  diagnosis  as  to  the 
locality  affected. 


LECTURE  VII. 

THE    SUBTHALAMIC   REGION,  THE   CORPORA    QUADRIGEMINA   AND   THE 
ORIGIN    OF   THE    OPTIC    NERVE. 

Gentlemen  :  In  the  last  lecture  we  postponed  tracing  the 
fibres  of  the  brain  downward,  in  order  to  consider  the  structures 
at  the  base  of  that  organ.  Let  us  again  take  up  the  thread  of 
our  discourse.  We  had  learned  that,  in  the  posterior  thalamic 
region,  the  bundles  of  the  internal  capsule  (except  so  far  as 
they  were  distributed  to  the  thalamus  itself,  or  to  the  subjacent 
ganglia)  emerge  free  on  the  base  of  the  brain  and  form  the  pes 
pedunculi.  Caudad  and  ventrad  of  the  thalamus  are  located 
the  nucleus  ruber  and  the  corpus  subthalamicum.  From  the 
internal  capsule  a  bundle  of  the  tegmental  radiation  passes  di- 
rectly caudad  to  these  structures,  while  another  first  passes 
through  the  corpus  striatum,  and  then  enters  into  relation  witli 
them,  after  passing  through  the  internal  capsule. 

Those  bundles  of  tegmental  fibres  which  passed  through 
the  corpus  striatum  may  be  traced  in  part  to  the  body  of  Luys 
(corpus  subtlialamicum).  Another  portion  of  them,  together 
with  the  fibres  originating  in  the  putamen  and  the  nucleus 
caudatus,  seem  to  pass  into  the  stratum  intermedium,  which  lies 
dorsad  of  the  substantia  nigra. 

The  fibres  of  tlie  regio  subthalamica  should  be  examined 
anew,  with  the  help  of  all  available  methods  of  investigation. 
Hitherto  they  have  been  examined  chiefly  by  means  of  sections 
taken  from  tlie  adult  brain.  (Meynert,  Forel,  Wernicke.)  The 
embryological  researches  of  Flechsig  and  myself  had  already 
enabled  us  to  distinguish  the  tegmental  fibres  amidst  the  chaos 
which  prevails  in  that  region. 

That  bundle  of  tegmental  fibres  which  passes  external  to 

(103) 


104  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

the  red  nucleus  apparently  becomes  the  upper  lemniscus.  This 
is  clearly  defined  and  medullated  in  a  foetus  of  seven  months. 
At  that  time  the  thalamus  contains  no  medullary  fibres  except 
the  bundle  of  Vicq  d'Azyr,  and  the  internal  capsule  none  except 
the  tegmental  radiation. 

Fibres  pass  from  the  thalamus  to  the  red  nucleus,  laminae 
medulläres  thalami,  while  others  go  to  the  corpus  subthalamicum. 
Between  the  pes  pedunculi  and  all  this  mass  of  ganglia  and 
fibres,  which,  taken  together,  are  called  the  tegmentum,  is 
situated  the  substantia  nigra. 

We  now  pass  into  the  region  of  the  mid-brain.  To  this 
region  belongs  (embryologically  considered)  that  thick  bundle  of 
white  fibres  which  passes  across  the  ventricle  at  the  point  where  it 
becomes  the  aqueduct  of  Sylvius ;  that  is  to  say,  the  posterior 
commissure  (Fig.  59).  It  can  be  more  easily  demonstrated  in  the 
lower  vertebrates  than  in  mammals  that  this  commissure  origi- 
nates in  ganglia  which  lie  on  each  side,  deep  in  the  inter-brain, 
near  the  median  line.  But,  even  in  mammals,  Meynert  has 
shown  that  its  bundles  are  evolved  from  the  thalamic  nuclei. 
They  then  pass  dorsad,  reach  the  surface,  and  cross  to  the  oppo- 
site side,  in  front  of  the  corpora  quadrigemina.  They  run 
horizontally  only  a  very  short  distance,  and  then  dip  down  into 
the  depths  of  the  mid-brain  tegmentum,  in  which  they  pass  still 
farther  caudad.  The  majority  of  the  fibres  under  consideration 
(as  I  have  seen  with  peculiar  distinctness  in  the  lower  animals) 
pass  laterally  and  ventrad  of  the  posterior  longitudinal  fascic- 
ulus, into  the  medulla  oblongata.  The  last-mentioned  fascic- 
ulus, which  we  shall  study  later  on,  only  attains  a  considerable 
size  after  receiving  these  fibres  from  the  commissura  posterior. 
Spitzka  and  Darkschewitsch  have  seen  a  similar  condition  in 
mammals.  According  to  the  views  of  the  latter,  the  more 
median  of  these  fibres  pass  into  the  nucleus  of  the  oculo-motor 
nerve.  Certain  it  is  that  they  pass  so  near  to  it  that  a  part  of 
them  seem  to  terminate  there.  The  fibres  can  be  seen  passing 
into  the  nucleus  from  the  same  and  from  the  opposite  half  of  the 


THE    SUBTHALAMIC    REGION,    ETC. 


105 


brain.  In  Fig.  72  these  fibres  originate  in  tlie  substantia  reticu- 
laris and  the  posterior  commissure,  and  this  is  probably  the 
truth.  In  all  vertebrates  the  posterior  commissure  is  one  of  the 
first  bundles  to  become  medullary  Its  development,  from  the 
simple  cyclostoma  up  to  human  beings,  is  always  conducted 
in  the  same  way. 

Under  the  aqueduct  the  structures  of  the  tegmentum  and 
the  fibres  of  the  pes  pedunculi  extend  farther  back.     Above 


Fig.  59. 

Diagram  of  a  section  through  the  vicinity  of  the  posterior  commissure.    Hhows  the 
ganglia  anil  the  course  of  some  of  the  fil)res  of  the  subthalamic  region. 


Bnuhen  Bahn,  Tegmental  tract. 


Stabler,  zum  Thalrnntix,  Coronal  fibres  to  tlie  thalamus. 


them  lie  tlio  corpora  quadrigemina  developed  from  tlie  roof  of 
the  mid-brain.  The  following  cut  shows  the  corpora  quadri- 
gemina viewed  from  above.  They  lie  on  the  crura,  and  seem  to 
be  crowded  in  b(!tw(>eii  the  thalami.  Ventrad  of  th(>m  appears,  on 
each  side,  a  thick  strand  of  fibres  from  the  depths  below,  which 
extend  into  the  cerebellum.  They  are  the  anterior  or  superior 
peduncles  of  the  cerebellum.  In  Fig.  53  you  can  see  how  they 
arise  in  the  red  nucleus,  which  is  situated  in  the  tegmentum 
beneath  the  thalamus  and  the  corpora  quadrigemina.     Behind 


106 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


the  latter  bodies  it  emerges  from  the  tegmentum  and  lies  on  the 
surface. 

We    distinguish    the  anterior   and   the   posterior    quadri- 
geminal  bodies.     This  distinction  is  only  visible   to  the  naked 


\entrtculus 
tertius. 


i  Zmisciienhirn 


■A',  irochkaris 
Hinifrhirn 


md-earm.. 


Hütkenmark . 


)bu. 


j^äserüjscy 


Fig.  60. 

The  brain-structures  from  the  thalamus  to  the  sphial  cord.    The  cerebellum  is  divided 

and  the  left  half  removed. 

Bindearm,  Peduncle.  Kleinhirn,  Cerebellum.  Ncichhim,  After-brain. 

ninterhim.  Hind-brain.  Mittelhirn,  Mid-brain.  Ruckenmark,  Sp.  cord. 

Birnschenkel,  Pedunc.  cerebri.  Zwischenhim,  Inter-brain. 

eye  in  the  case  of  some  mammalians ;  in  all  other  vertebrates  the 
anterior  quadrigeminal  bodies  are  so  large  that  the  posterior 
ones  disappear  beneath  thpm,  and  seem  like  a  little  ganglion 


THE    SUBTHALAMIC    REGION,    ETC. 


107 


attached  to  the  anterior  pair.  (Compare  Lecture  II,  Figs.  11- 
17.)  From  the  anterior  quadrigemliial  bodies  arise  a  large  por- 
tion of  the  optic  nerve-fibres.  They,  Uke  the  thalamus,  receive 
fibres  from  the  region  of  the  occipital  lobe,  which  run  in  the 
optic  radiation  to  the  internal  capsule,  and  from  there  pass  up- 
ward to  the  thalamus  in  the  brachium  of  the  anterior  quadri- 


FiG.  CI. 
Thalamus  and  corpora  quadriireinina  seen  from  the  side.    The  fore-brain  ha-s  been 
removed  at  the  point  where  the  fibres  of  the  corona  radiata  enter  the  mternal  <tapsule. 
The  rehition  of  the  oj)tic  radiation  to  the  posterior  part  of  the  capsule  and  to  tlie  optic 
centres  is  shown  in  diagram. 

B.m/««rn»,  Peduncle.  F.<»»,  Cnista  ffmr.  ^rm,  Post,  brachium. 

Stahkranz  zu  den  Optic  Cmtr.,  Coronal  fibrea  to  the  optic  centres. 

V.  Arm,  Ant.  brachium. 

geminal  body.  In  this  brachium  antcrius  the  fibres  pass 
downward  to  the  optic  tract.  The  brachium  anterius,  which  is, 
therefore,  composed  of  fibres  from  the  cortex  and  of  fibres  to 
the  optic  tract,  passes,  with  the  fibres  from  the  cortex  only,  into 
the  corpora  quadrigemina.     The  fibres  to  the  optic  nerve  spread 


108  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

over  the  gray  surface  of  the  quadrigemmal  body  (stratum  zonale) 
and  end  in  a  fine  net-work,  which  apparently  takes  its  origin  in 
the  numerous  delicate  cells  which  are  found  in  this  locality. 

The  posterior  quadrigeminal  body  appears  also  to  stand  in 
some  relation  with  the  optic  tract,  but  it  is  very  improbable  that 
it  contains  fibres  which  are  of  any  use  in  the  visual  act.  Its 
brachium  originates  in  the  corpus  geniculatum  mediale  and  in 
the  hitherto  unmentioned  commissura  inferior  (Gudden's  com- 
missure), which  passes  along  with  the  optic  tract  to  the  posterior 
angle  of  the  chiasm.  (See  Fig.  66.)  It  may  also,  perhaps,  con- 
tain fibres  from  the  temporal  lobe.  The  extraordinary  develop- 
ment of  the  posterior  quadrigeminal  body  in  cetaceans,  and  the 
huge  bands  of  fibres  which  pass  from  it  to  the  nucleus  of  the 
acoustic  nerve,  make  it  probable  (Spitzka)  that  this  ganglion 
stands  in  some  relation  to  the  sense  of  hearing.  The  results  of 
experiments  undertaken  to  elucidate  the  point  seem  to  agree 
with  this.  After  destruction  of  the  acoustic  nerve  the  posterior 
quadrigeminal  body  is  said  to  become  somewhat  atrophied 
(Baginski).  It  seems  to  me,  however,  that  this  special  point 
needs  further  investigation. 

Viewed  laterally  the  relations  of  the  quadrigeminal  brachia 
to  the  ganglia  and  the  optic  tract  are  plainly  seen ;  also  the 
situation  of  the  corpora  geniculata;  the  corpus  geniculatum 
mediale  lying  close  to  the  posterior  brachinm,  and  the  corpus 
geniculatum  laterale  seeming  to  be  thrust  between  the  pulvinar 
and  the  optic  tract.  The  corpus  geniculatum  laterale  was  men- 
tioned when  we  were  describing  the  thalamus.  From  the  latter 
ganglion  fibres  pass  to  the  optic  tract  aside  from  those  which 
issue  from  the  pulvinar  and  the  stratum  zonale.  The  optic 
fibres,  from  the  anterior  quadrigeminal  body,  have  already  been 
described.  They  run  their  course,  to  a  great  extent,  in  its 
brachium.  Besides  these  the  nerve  receives  roots  from  the 
region  of  the  corpus  subthalamicum,  and  from  the  gray  matter 
in  the  vicinity  of  the  infundibulum  (basal  optic  root).  Compare 
Fig.  66. 


THE    SUBTHALAMIC    REGION,    ETC.  109 

We  have  now  reviewed  the  origin  of  the  optic  nerve  as  shown  in  dissections 
of  the  adult  human  brain.  According  to  J.  Stilling,  there  is  added  still  another 
root  which  ascends  in  the  pedunculus  cerebri  from  the  medulla  oblongata. 
However,  all  these  fibres  and  nuclei  are  so  difficult  to  locate  and  follow  out  in  the 
human  being  that  we  must  ask  ourselves  the  question  how  far  these  discoveries 
are  borne  out  by  investigations  on  the  lower  animals.  Comparative  anatomy 
furnishes  us  an  opportunity  to  study  optic  tracts  of  such  a  comparatively  huge 
size  (in  fi.*hes  and  birds)  that  the  relations  of  these  parts  can  be  mucii  more 
easily  determined.  From  the  study  of  these  animals,  as  well  as  of  reptiles  and 
amphibians,  we  can  see  that  the  optic  nerve,  as  a  whole,  certainly  originates  in 
the  anterior  quadrigeminal  body;  that  in  its  course  past  the  lateral  geniculale 
body  it  receives  fibres  from  that  ganglion  ;  and  that,  finally,  a  basal  root  from  tin; 
region  behind  the  infundibulum  is  associated  with  it.  Experimental  researches 
on  mammals  (Gudden,  Ganser,  Monakow)  show  that  the  early  extirpation  of  an 
eye  is  followed  by  degeneration  of  the  anterior  quadrigeminal  body,  of  the  corpus 
geniculatum  laterale,  and  of  fibres  from  the  pulvinar.  The  pulvinar  is,  however, 
very  small  in  most  mammals,  and  first  attains  a  considerable  size  in  the  primates. 

We  may  regard  it  as  definitely  settled  that  the  optie  nerve 
has  its  origin  in  the  anterior  quadrigeminal  body,  the  corpus 
geniculatum  laterale,  the  pulvinar,  the  stratum  zonale,  and  the 
base  of  the  brain.  Tlie  roots  from  the  corpus  geniculatum 
mediale,  the  corpus  subthalamicum,  and  the  pedunculus  cerebri 
have  not  received  the  necessary  corroboration  by  the  various 
methods  of  investigation. 

The  connections  between  the  cortex  of  the  occipital  lobe 
and  some  of  the  points  of  origin  of  the  optic  nerve  have  already 
been  discovered.  These  connecting  fibres  make  up  the  optic 
radiation,  whicli  passes  from  the  occipital  lobe  to  the  most 
posterior  part  of  the  internal  capsule,  and  from  this  point  (an 
be  traced  into  the  tlialamus  and  the  bracliium  of  tlie  anterior 
quadrigeminal  body.  It  is  shown  in  Fig.  44.  Its  ;Kbre.<:,  liow- 
ever,  do  not  end  as  tliere  represented,  in  the  lateral  portions  of 
the  occipital  lobe,  but  trending  toward  the  median  line,  in  planes 
which  lie  outside  of  this  section,  extend  as  far  as  the  cuneus. 
In  destructive  disease  of  the  occipital  lobe  and  of  tlie  ])Osterior 
part  of  the  internal  capsule  the  same  symptoms  appear  as  in 
similar  lesions  of  the  optic  tract  on  the  same  side.  The  outer 
half  of  the  retina  of  the  eye  on  the  injured  side  and  the  inner 
half  of  the  retina  of  the  opposite  eye  degenerate. 


110 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


Let  US,  now  that  we  have  learned  something  concernmg 
the  region  of  the  corpora  quadrigemina,  take  up  the  study  of  a 
section  made  perhaps  5  millimetres  behind  the  structures  shown 
in  Fig.  59.  This  section  divides  the  two  pairs  of  quadrigeminal 
bodies,  passes  through  the  underlying  tegmentum,  and  lastly 
through  the  pedunculus  cerebri. 

Let  us  first  study  those  structures  which  we  have  already 


iorcicrci- 

Vie^  hticfel 

Arm 
ilesViethvqi!' 


Gtrpffs  ifetifc'med. 
Pi/iyi/fiAr 


/   /  -f :• 


y  ' 


Corpus  ^enic.  hit 


Substaniia  nigra . 
Hf uteres  LangshiJndeL 


Fig.  62. 
Cross-section  through  the  antei'ior  quadrigemmal  bodies  (somewhat  diagrammatic). 

Arm,  des  VierhUrjeh;  Brachium  of  corpus  quadrigeminum. 
Sauhe,  Tegmentum.  Hinteres  L'iagshiindel,  Post.  longitud.  fasciculus.  Fuss,  Cnista. 

Pyramis,  Pyramid.  Rolher  Kern,  Red  nucleus.  Schleife,  Fillet. 

Vorderer  Vierhügel,  Anterior  quadrigeminal  body. 


met  with.  Externally  on  each  side  is  the  pulvinar  thalami, 
from  which  the  optic  nerve  seems  to  arise,  the  corpus  genicu- 
latum  laterale,  as  it  were,  inserted  into  its  course.  It  receives 
a  thick  auxiliary  bundle  from  the  brachium  of  the  anterior 
quadrigeminal  body  (shown  most  clearly  on  the  left),  above 
which  you  will  recognize  the  corpus  geniculatum  mediale,  which 
has  been  cut  into  by  the  section. 

Below  the  pulvinar  arises  the  pedunculus  cerebri.     At  this 


THE    SUBTHALAMIC    REGION,    ETC. 


Ill' 


point  it  contains  tlie  following  tracts:  1.  The  fibres  from  the 
motor  region  of  the  cortex,  wliich  we  have  learned  to  know  as 
the  pyramidal  tract  in  both  the  corona  radiata  and  the  internal 
capsule.  They  lie  near  the  middle  and  are  slightly  shaded  in 
the  cut.  2.  The  fibres  from  the  frontal  lobe  to  the  pons,  situ- 
ated internal  to  the  pyramidal  tract.  3.  The  fibres  from  the 
occipital  lobe  to  the  pons.  They  are  situated  external  to  the 
pyramidal  tract.  Above  these  th^ee  divisions  of  the  pes  pedun- 
culi,  of  which  the  first  mentioned  earliest  receives  a  medullary 
covering,  are  foinid  fibres  apparently  from  the  corpus  striatum, 
which  are  not  designated  in  the  cut  (compare  Fig.  50), — Mey- 
nert's  stratum  intermedium, — and 
then  comes  the  substantia  nigra,  an 
aegreofation  of  fine  nerve-fibres  and 
"•an«iion-cells  whose  sionificance  is 
wholly  unknown.  External  to  this 
(</,  in  Fig.  62)  lies  another  little 
ganglion,  which,  so  far  as  I  know, 
has  never  been  described. 

In  the  tegmentum  you  will  at 
once  notice  the  two  large,  round, 
gray  bodies ;  they  are  the  red  nuclei 
(compare  Fig.  59) ;  the  corpus  sub- 
thalamicum,  which  is  shown  near  it 
in  Fig.  54,  has  disappeared  when  we  reach  this  level. 

The  red  nucleus,  which  receives  fibres  from  the  thalamus 
(and  tegmental  radiation "?),  is,  at  this  point,  i.e.,  under  the  cor- 
pora quadrigemina,  very  rich  in  medullary  fibres.  These  pass 
under  the  posterior  quadrigeminal  body  toward  the  middle  line, 
and  decussate?  with  the  fibres  of  the  opposite  side.  They  belong 
to  the  superior  peduncles  of  the  cerebellum.  The  decussation 
is  called  the  decussation  of  the  superior  cerebellar  peduncles. 
It  is  shown  in  Fig.  63.  Farther  back  the  crossed  cerebellar 
pedunculi  develop  into  thick  bundles  of  fibres,  which  lie  external 
to  the  red  nucleus ;  they  gradually  attain  a  still  more  external 


Fig.  63. 

Commencement  of  the  pons  in  a 
newborn  child.  HaRmatoxylin  stain- 
ing. Decussation  of  the  "cerebellar 
peduncles. 


-112 


LECTURES    ON    THE  .  CENTRAL    NERVOUS    SYSTEM. 


position,  and  finally  reach  the  surface.     From  here  they  pass 
hackward  to  the  cerebellum,  as  is  shown  in  Fig.  60. 

A  section  made  almost  horizontally  through  the  thalamus, 
the -corpora  quadrigemina,  and  the  cerebellum,  following  ,  the 
course  of  the  superior  cerebellar  peduncles,  would  give  us  the 
relations  between   the  thalamus,  the  nucleus  ruber,  tegmental 


I 


/ 


j:f,^^i"^¥ 


Fig.  64. 

A  diagrammatic  horizontal  section  tlirougli  tlie  decussation  of  the  anterior  cerebellar 
peduncles  and  its  vicinity.    The  tract  of  fibres  to  the  optic  nerve  is  doubtful. 

Bindearm,  Peduncle.  Region  der  VierliUgel,  Quadrigeminal  region. 

Direkte  Fasern  zum  Thalamus,  Direct  fibres  to  thalamus.     Hauben  Strahlung,  Tegmental  radiation.     • 

Bothen  Kern,  Red  nucleus. 

striation,  pedunculus  cerebelli  superior,  and  the  cerebellum, 
somewhat  as  they  are  depicted  in  Fig.  65. 

In  the  cerebellum  the  superior  peduncles  enter  the  corpus 
den  ta  tum. 

External  to  the  red  nucleus  there  is  shown  in  Fig.  62  a 
bundle  of  fibres  which  appear  to  emerge  from  under  the  corpora 


THE    SUBTHALAMIC    KEGIOX,    ETC. 


113 


quadrigemina,  and  whicli  have  been  cut  off  obliquely.  They 
pass  backward  in  the  region  over  the  substantia  nigra.  These 
fibres  arise  in  great  part  from  the  ganglia  of  the  corpora  quad- 
rigemina. They  are  called  the  lower  fillet.  The  ujjper  fillet, 
which  arises  mainly  from  the  tegmental  striation,  or,  rather, 
from  the  ansa  lenticularis,  lies,  at  tlie  level  wliicli  we  are  now 
considering,  just  outside  of  and  below  the  red  nucleus,  and  aj> 
pears  as  a  separate  bundle  of  transversely  divided  fibres.     To 


Fig.  65. 

A  frontal  section  ma<lc  in  an  oblique  direction  trending  downward  and  backward 
fdirection  of  se<tion  slinwn  in  small  figure).  It  contains  the  greater  part  of  the  origin 
of  the  midbrain  fillet.    Haematoxvlin  stain. 


Centr.  nöhlmqrau.  Central  (rray  m.itter. 
Schlei/'enschicht  dee  Potu,  Stratum  lemnisci  of  the  pon». 


Schnittrirhlung,  Plane  of  Eection. 
7¥e/>»  Hark,  Deep  marrow. 


the  inner  and  outer  sides  of  it  the  fibres  of  the  lower  fillet  are 
joined  to  it.  Thus  it  comes  that  there  is  a  wide  area  of  trans- 
versely divided  fibres  just  above  the  substantia  nigra,  and  tliis  is 
called  the  layer  of  the  fillet  (stratum  lemnisci). 

The  greater  part  of  the  layer  of  the  fillet  can  be  traced  caudad  to  the 
nuclei  of  the  sensory  nerves  and  of  the  posterior  column.  Meynert  first  showed 
that  this  was  a  portion  of  the  sensory  tract.  Embryology  and  comparative 
anatomy  equally  bear  out  this  view.  We  shall  study  the  course  of  the  fillet 
later. 

8 


114  LECTURES    OlSr    THE    CENTRAL    NERYOUS    SYSTEM. 

The  stratum  lemnisci,  then,  contains  two  elements, — the 
upper  and  the  lower  fillets.  The  lower  (better,  mid-brain)  fillet 
arises  chiefly  from  a  system  of  fibres  which  has  not  been  men- 
tioned before,  the  deep  marrow  of  the  roof  of  the  mid-brain  ;  but 
it  also  arises  in  part  from  the  ganglion  of  the  posterior  quadri- 
geminal  body.  This  is  clearly  shown  in  an  oblique  section  down- 
ward through  both  pairs  of  quadrigeminal  bodies,  as  represented 
in  Fig.  65.  The  ganglion  above  mentioned  consists  of  a  large, 
roundish  nucleus  permeated  by  a  net-work  of  fine  fibres.  This 
is  the  only  ganglion  situated  in  the  posterior  quadrigeminal 
body ;  the  latter,  therefore,  does  not  present  that  stratified  ap- 
pearance, alternately  gray  and  white,  which  is  characteristic  of 
the  anterior  quadrigeminal  body, — the  ganglion  opticum.  It  is 
connected  with  its  fellow  of  the  opposite  side  by  the  fibres  run- 
ning over  the  aqueduct  of  Sylvius. 

Phylogenetically  the  deep  marrow  is  a  very  old  system. 
It  is  present  even  in  the  simple  brains  of  the  lower  vertebrates, 
and  in  these,  as  in  the  human  being,  early  receives  its  medullary 
sheaths.  Its  fibres  arise  in  the  roof  of  the  mid-brain,  springing 
from  layers  which  lie  beneath  the  origin  of  the  optic  nerve. 
From  this  point  they  at  first  radiate  inward,  but,  on  reaching 
the  central  gray  matter,  they  turn  and  run  ventrad.  The  most 
lateral  of  these  fibres,  united  with  those  which  come  from  the 
opposite  side,  pass  into  the  lemniscus ;  the  more  median  fibres, 
however,  pass  down  around  the  aqueduct  of  Sylvius  and  declis- 
sate  with  the  analogous  fibres  of  the  opposite  side.  In  human 
beings  the  termination  of  these  fibres  has  not  yet  been  made 
clear.  We  call  them  by  the  name  proposed  by  Forel,  the 
"  fountain-like"  decussation  of  the  tegmentum  (Figs.  66,  70,  72). 
In  fishes  and  birds  these  particular  fibres  of  the  deep  marrow 
are  so  extensively  developed  that  their  course  is  much  more 
readily  recognizable.  In  them,  as  well  as  in  amphibians  and 
reptiles,  we  see  that,  except  so  far  as  they  pass  into  the  fillet, 
this  system  of  fibres  is  contained  wholly  in  the  mid-brain  and 
terminate  in  cells  situated  both  on  the  same  and  on  the  opposite 


THE    SUBTHALAMIC    REGION,    ETC. 


11; 


sides.  In  human  beings  we  find  groups  of  cells  at  points  cor- 
responding to  these  terminal  cells  of  birds,  fishes,  etc.  (lateral 
and  median  ganglion.  Fig.  66). 

In  the  central  gray  matter,  under  the  corpora  quadrigemina, 
we  first  meet  with  ganglion-cells  which  give  origin  to  a  cranial 
nerve, — the  oculo-motor.  From  their  union,  which  forms  the 
oculo-motor  nucleus,  the  roots  of  that  nerve  pass  ventrad 
through  the  tegmentum  and  the  crusta  to  the  anterior  surface 
of  the  brain,  and  emerge  in  thick  bundles.    (See  Fig.  72.)    The 


Fig.  66. 

The  fibres  arising  in  the  mid-brain  roof.    Dorsad  the  optic  tract,  ventrad  the  deep 
marrow.    The  diagram  also  shows  the  other  optic  roots. 

oculo-motor  nerve  contains  fibres  to  several  internal  and  external 
muscles  of  the  eye.  From  tlie  fact  that  nuclear  paralyses  of 
single  muscles  from  the  group  supplied  by  this  nerve  have  been 
observed,  it  is  probable  that  this  nucleus  consists  of  a  complex 
of  small  nuclei  somewhat  separated  from  each  other.  In  human 
beings,  indeed,  a  distinct  demarcation  can  be  made  out  in  several 
parts.  Far  forward,  lying  partly  in  the  lateral  wall  of  the  third 
ventricle  on  each  side,  is  a  small  nucleus, — the  nucleus  anterior. 
It  sends  a  few  fibres  caudad  to  the  main  portion  of  the  nerve. 
Behind  it  lies   the   nucleus  posterior.      It  extends   the  whole 


116 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


length  of  the  aqueduct  of  Sylvius,  and  is  composed  of  large 
multipolar  ganglion-cells.  In  this  nucleus  we  observe  a  certain 
tendency  in  the  cells  to  become  separated  into  groups.  One 
collection  of  cells  lying  dorsad  of  the  rest  is  plainly  distinguish- 
able. While  all  the  other  oculo-motor  fibres  emerge  from  tlie 
side  on  which  they  originate,  the  fibres  from  this  group  of  cells, 
as  was  first  shown  by  Gudden,  pass  in  a  median   direction  and 

decussate  with  those  from  the  corre- 
sponding group  on  the  opposite  side. 
Besides  this  dorsal  group  a  median 
group  can  be  distinguished,  just  in 
the  middle  line,  which  gives  off 
fibres  on  each  side. 

Fig.  67  represents,  partly  in 
diagram,  the  nuclei  in  the  floor  of 
the  aqueduct  and  their  relations  to 
the  nerve-roots.  You  will  notice  in 
the  cut  two  small  nuclei  situated 
one  on  each  side  of  the  median  line, 
and  connected  with  each  other  ante- 
riorly and  below.  They  are  marked 
a  and  h.  These  two  nuclei,  which 
were  first  observed  by  myself  in  foetal 
brains,  and  later  by  Westphal,  dur- 
ing a  painstaking  exg^iination  of  the 
adult  brain,  lie  in  a  «thick  net- work 
of  nerve-fibres.  It  is  not  yet  known 
whether  they  stand  in  any  relation 
to  the  oculo-motor,  and,  if  they  do,  what  the  rdation  is.  We 
possess  such  an  array  of  clinical  facts  and  discoveries  made  by 
careful  post-mortem  dissections  that  we  may  venture  to  desig- 
nate the  particular  spot  in  the  nucleus  which  supplies  each 
individual  ocular  muscle. 

I   will  give  you  Starr's  table,  the  latest   result  of  these 
researches  which  were  so  happily  begun  by  Kahler.    According 


Fig.  67. 
The  floor  of  the  aqueduct  of  Syl- 
vius looking  upward.     The  nuclei  of 
the  oculo-motor  and  trochlear  nerves. 
(Partly  diagrammatic.) 


THE    SUBTHALAMIC    REGION,    ETC.  117 

to  this  table,  the  nuclei  of  the  individual  muscles  are  arranged 
in  the  order  given  below,  from  before  backward,  thus : — 


Sphincter  iridis. 

Musculus  ciliaris. 

G> 

Levator  palp. 

Rectus  int. 

S  i 

Rectus  sup. 

Rectus  inf. 

Obliquus  inf. 

The  nerves  to  the  internal  muscles  of  the  eye  apparently 
spring  from  the  anterior  nucleus.  The  crossed  track  and,  per- 
haps, also  the  median  division  of  the  posterior  nucleus  are 
accredited  to  the  rectus  internus.  Although  clinical  experience 
teaches  that  there  is  both  a  direct  and  a  crossed  communication 
between  the  oculo-motor  nerve  and  the  centres  of  the  optic 
nerve,  yet  the  anatomical  basis  of  this  fact  has  not  been  dis- 
covered. Net-works  and  bundles  of  fibres  which  might  com- 
plete the  communication  are  to  be  found  in  this  region.  As  yet, 
however,  no  experlmentinn  cnicis  has  been  performed,  nor  has 
there  been  made  any  clinical  observation  supported  by  post- 
mortem examination  which  would  clear  up  this  point. 

The  nucleus  of  the  ocido-motor  lies  ventrad  of  the  aque- 
duct of  Sylvius ;  that  is  to  say,  in  its  floor.  Later  on,  as  we 
pass  gradujilly  backward  in  our  study  of  the  tegmentum,  we 
shall  find  the  nuclei  of  most  of  the  other  cranial  nerves  in  the 
region  of  this  floor. 

The  cranial  nerves  all  arise  directly  from  their  nuclei.  To 
each  of  these  nuclei  fibres  pass  from  higher  parts  of  the  brain. 
They  come  from  the  opposite  side  and  decussate  in  the  middle 
line  before  entering  the  nucleus.  Clinical  experience  goes  to 
show  that  the  upper  part  of  the  cranial-nerve  tracts — that  is, 
above  the  nucleus — extends  to  the  cerebral  cortex. 

The  course  of  the  fibres  in  the  vicinity  of  tlie  thalamus  and  in  the  regio 
subthalaniica  is  less  certainly  known  than  in  most  other  parts  of  the  brain. 
Amons  the  workers  in  this  difficult  field,  Meynert,  Forel,  Gudden,  Flechsig, 
Wernicke,  and  the  author  are  to  be  mentioned. 

Tlie  origin  of  the  optic  nerve  has  been  piincipally  worked  out  by  Meynert, 
J.  Stilling,  Tartuferi,  Gudden,  IJelloiici,  and  Monakow. 

You  will,  gentlemen,  have  a  better  comprehension  of  many 
pathological  nervous  phenomena  if  you  will,  for  the  time,  adopt 


118 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


the  following  diagram  of  an  innervation  tract.  Every  peripheral 
nerve — at  least,  every  motor  nerve — ends  in  the  central  organ 
in  a  nucleus.  Nerve-roots  and  the  nucleus  form  the  first  part 
of  the  tract.  To  the  nucleus  there  pass  fibres  of  the  corona 
radiata  from  the  cortex  of'  the  hemispheres,  and  thus  is  formed 
the  second  link  in  the  chain :  nerve,  nucleus — corona  radiata, 
cortex. 


Diagram  of  an  innervation  tract  from  the  cortex  to  a  (motor)  cranial  nerve. 

Bahn  in  Stabkranz  u.  Capsula,  Tract  in  corona  radiata  and  capsule. 
Hinteres  L'dngsbUndel,  Post,  longitud.  fascicnlua.        Kern,  Nucleus.        Periph.  Nerv,  Peripheral  nerre. 

Rinde,  Cortex. 

So  long  as  the  first  part  of  the  tract  is  intact,  the  muscles 
can  be  brought  into  action  by  electric,  mechanical,  or  reflex  irri- 
tation, and,  in  animals,  to  a  certain  extent  by  the  influence  of 
the  will.  If  either  nerve  or  nucleus  is  destroyed  we  have  abso- 
lute paralysis.  In  order,  however,  to  obtain  the  full  effect  of  a 
conscious  voluntary  act,  the  second  part  of  the  tract  must  also 
be  intact ;  this  is  particularly  true  of  the  highly-developed  human 


THE    SUBTHALAMIC    REGION,    ETC. 


119 


brain,  for,  if  tlie  second  part  is  interrupted,  there  can  no  longer 
be  a  voluntary  motion  of  any  kind.  In  a  case  of  apoplectic 
rupture  of  the  internal  capsule  the  muscles  of  tlie  opposite  side 
of  the  body  are  not  really  paralyzed ;  they  simply  cannot  be 
made  to  contract  by  the  will.  This,  however,  can  readily  be 
accomplished  by  other  forms  of  stimulation.  It  is  otherwise  in 
a  case,  for  instance,  of  infantile  paralysis,  where  a  nerve-nucleus 
itself  is  destroyed.  In  this  case  we  have  a  true  paralysis,  gener- 
ally irremediable,   which   leads    to    atrophy,  and  the  muscles 


Vent 


Fig.  69. 

Longitudinal  section  through  the  quadrigeminal  region  of  a  human  embryo  of  28 
weeks,  near  the  median  line.  The  outer  wall  of  the  aqueduct  of  Sylvius  has  been  cut 
into.  Termination  of  the  fasciculus  longitudinalis  posterior  in  the  nucleus  of  the  oculo- 
motor.   All  medullary  fibres  stained  with  haematoxylm. 

Hint.  LänijsbUndel,  Posterior  longitudinal  fasciculus.  Hirnschenkel,  Feduncalus  cerebri. 

Vierhiigelplatte,  Quadrigeminal  laminu. 

respond  very  little,  if  at  all,  to  reflex  or  any  other  stimulation. 
It  makes  a  great  difference,  so  far  as  the  prospect  of  a  restora- 
tion of  function  is  concerned,  whether  the  cerebral  or  the  deeper 
portion  of  the  innervation  tract  is  affected. 

The  diagram  Fig.  68  is  an  aUempt  to  represent  the  most  important  fibres 
passing  to  the  nucleus  of  a  cranial  nerve.  Besides  the  above-described  central 
tract,  the  nucleus,  and  the  peripheral  tract,  you  will  notice  fibres  connecting  the 
nerve-nucleus  w^ith  deeper-lying  nuclei  of  other  nerves,  and,  in  addition  to  these, 
»till  other  fibres  arising  from  the  nucleus,  but  emerging  from  the  central  organ  in 
the  nerve  of  the  opposite  side. 


120  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

Ill  the  begimiing  of  to-day's  lecture  you  learned  that  cer- 
tain fibres  of  the  posterior  commissure  curved  backward.  These 
fibres,  together  with  others  which  arise  in  the  depths  of  the 
inter-brain,  are  met  with  as  a  fine  fasciculus  ventrad  of  the 
anterior  oculo-motor  nucleus.  As  we  pass  back,  this  fasciculus 
progressively  increases  in  size.  There  are  added  to  it  numerous 
fibres  from  the  nucleus  of  the  oculo-motor.  We  shall,  from 
now  on,  meet  with  the  triangular  cross-section  of  this  bundle, 
which  is  composed  of  fibres  from  such  various  regions  on  every 
transverse  section  of  the  brain,  from  the  level  of  the  corpora 
quadrigemina  down  to  the  beginning  of  the  spinal  cord.  This 
bundle  is  called  the  fasciculus  longitudinalis  posterior.  Inasmuch 
as  fibres  are  given  off"  along  the  whole  course  of  this  bundle  to 
the  nerve-nuclei,  as  can  be  plainly  seen  in  embryos  of  the  sixth 
to  seventh  month,  when  few  other  fibres  are  medullated,  and,  as 
this  bundle  projects  farther  back  than  the  nucleus  of  the  abdu- 
cens,  it  is  probable  that  the  fasciculus  longitudinalis  posterior  not 
only  contains  the  fibres  of  communication  between  the  nuclei 
of  the  ocular  muscles,  but  that  it  also  contains  fibres  to  other 
cranial  nerves.  Flechsig  is  also  of  this  opinion.  I  have  never 
succeeded  in  tracing  this  fasciculus  farther  than  the  nucleus  of 
the  oculo-motor  previous  to  the  ninth  month.  Series  of  longi- 
tudinal sections  stained  with  hsematoxylin  (one  of  which  is 
represented  on  preceding  page)  are  decisive.  Not  all  fibres  of 
the  fasciculus  longitudinalis  posterior  receive  their  medullary 
substance  at  the  same  time. 

In  the  neighborhood  of  the  posterior  quadrigeminal  body 
there  is  an  interchange  of  fibres  between  the  two  fasciculi  longi- 
tudinales  posteriores.  By  this  means  there  is  established  a  com- 
munication between  the  oculo-motor  and  the  trochlear  on  one 
side  and  the  opposite  abducens. 

The  numerous  systems  of  fibres  which  run  their  course  in 
the  region  of  the  corpora  quadrigemina  can  only  be  differen- 
tiated by  studying  the  development  of  their  medullary  sheaths. 
I  should  therefore  dislike  extremely,  gentlemen,  to  close  these 


THE    SUBTHALAMIC    REGION,    ETC. 


121 


lectures  witliout  demonstrating  to  you  a  specimen  which  has  a 
bearing  upon  this  subject. 

In  Fig.  70  we  liave  a  section  through  the  anterior  quadri- 
geminal  body,  close  to  the  posterior  commissure,  from  a  child 
born  during  the  ninth  foetal  month.  Every  one  of  the  fibres 
which  are  medullary  at  this  period  is  stained  black  by  heema- 
toxylin. 

You  will  easily  make  out  the  features  which  we  have  just 
described.     Here  your  attention  is,  for  tliQ  first  time,  called  to  a 


'"CrACt  opt 
Fig.  70. 
Frontal  section  through  the  anterior  quadrigeminal  body  of  a  9  months'  foetus. 
Binl.  Langnh.,  Posterior  longitudinal  fasciculus.  O.  S.,  Upper  fillet.  U.  S..  Lower  fillet. 

little  circular  binidle  of  transversely  divided  fibres  lying  between 
the  red  nuclei,  and  marked  b.  It  arises  in  the  ganglion  habe- 
nulse  and  passes  baclcward  to  a  small  ganglion  which  lies  be- 
tween the  crura  cerebri,  and  is  called  the  ganglion  inter- 
pedunculare.  In  that  situation  the  fibres  decussate  with  those 
of  the  opposite  bundle  before  entering  the  ganglion.  This 
bundle  is  called  the  fasciculus  retroflexus,  or  Meynert's  bundle. 
Its  course  is  shown  in  Fig.  71.     Compare  also  Fig.  59. 

You  see  in  Fig.  70  a  mass  of  fibres  belonging  to  the  lem- 
niscus and  passing  around  outside  the  red  nucleus  to  the  region 
over  the  substantia  nigra.     In  the  crusta  there  is  at  the  ninth 


122 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


month,  only  one  small  fasciculus,  which  has  become  medullary. 
It  lies  externally,  and  is  not  shown  in  the  cut.  It  emerges 
probably  from  the  ansa  lenticularis. 

In  Fig.  72  we  have  a  picture  which  represents  most  of  the 
structures  which  can  be  seen  in  a  section  just  behind  the  ante- 
rior quadrigeminal  body.  This  cut  is  prepared  from  specimens 
at  various  periods  of  development.  We  will  make  use  of  it  for 
a  review  of  to-day's  lecture,  and  look  up  the  following  important 
points : — 

1.  Roof  of  mid-brain  :  Anterior  quadrigeminal  body;  from 


Fornk. 


Fig.  71. 
Diagram  of  a  sagittal  section  through  the  thalamus  and  the  corpora  quadrigemina. 

Bindearm,  Sup.  cerebellar  pedunc.  Haubenbiindel,  Tegmental  fasoicnlus. 

Viq.  d'Azyr.  B.,  Viq.  d'Azyr's  bundle. 

this  there  arises  dorsad  the  brachium  to  the  optic  nerve,  ventrad 
the  deep  marrow,  the  decussation  of  the  latter  over  the  aque- 
duct, the  central  gray  matter  surrounding  the  aqueduct.  On  the 
outer  border  of  the  central  gray  matter  a  small  nucleus,  unmen- 
tioned  before,  whose  vesicular  cells  will  be  found  in  the  same 
relative  position  throughout  the  entire  mid-brain.  From  it 
arises  a  slender  bundle  of  fibres  which,  progressively  increasing 
in  size,  passes  downward  to  the  pons  and  there  associates  itself 
with  the  emerging  fibres  of  the  trigeminus.  It  is  the  descend- 
ing root  of  the  fifth  nerve. 

2.  Tegmentum  :  In  the  ventral  portion  of  the  central  gray 


THE    SUBTHALAMIC    REGION,    ETC. 


123 


matter  the  nucleus,  posterior  medialis,  and  lateralis  of  the  oculo- 
motor ;  to  it  are  added  fibres  from  the  deep  marrow  and  from 
the  fasciculus  longitudinalis  posterior ;  external  to  and  continu- 
ous with  the  latter  the  fibres  ol'  the  posterior  commissure.     Ex- 


FlG.  72. 


Section  just  back  of  the  anterior  quadrigeminal  body,  combined  from  specimens  at 
different  stages  of  medullary  development.    Hsematoxylin  staining. 

Au«  Corput  ftriat..  From  the  corpus  striatum. 
Aus  L*ih.  tnnporatijt  und  pariHali»^  From  the 

temporal  andparietal  lobes. 
Au»  Lub.frtmt.,  From  the  frontal  lobe. 


Auk  TttnlamuK,  From  the  thalamus. 

Centr.    Höklenijrau,    Central    (ventricular)   gray 

matter. 
TUfe»  Mark.  Deep  marrow. 


tenial  to  this  a  medullary  tract,  which  apparently  extends  hither 
from  the  thalamus,  from  which  it  took  its  departure  in  the  form 
of  the  lamiricJü  medulläres.  Tlie  fillet  from  the  corpora  quad- 
rigemina,  and  that  i'rom   the  tegmental  radiation  ;   internal  to 


124  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

tlie  fillet  is  the  nucleus  ruber  tegmenti,  from  which  the  numerous 
fibres  of  the  superior  cerebellar  peduncles  arise.  Near  the 
median  line  is  that  decussation  of  the  fibres  of  the  deep  marVow 
Avhich  has  been  named  the  "  fountain-like  "  decussation  of  the 
tegmentum.  Between  the  latter  and  the  pedunculus  superior 
cerebelli  is  seen  a  portion  of  the  descending  fasciculus  retro- 
fiexus.     Fig.  71  shows  how  it  reached  this  region. 

3.  On  the  boundary  between  the  crusta  and  the  tegmentum 
we  recognize  the  substantia  nigra  Sommeringi,  in  which  run 
many  fibres, — stratum  intermedium, — which  arises  in  the  len- 
ticular nucleus. 

4.  Pes  pedunculi :  The  pyramidal  tract  is  shown  still  non- 
medullary,  as  it  appeared  in  the  specimen  from  a  4-week-old 
child.  The  fibres  lying  internal  to  it  come  from  the  frontal 
lobe  ;  those  on  its  outer  side  from  the  parietal  lobe.  At  about 
this  level  one  bundle  leaves  the  pyramids,  and,  passing  along  the 
border  of  the  pes,  becomes  associated  farther  back  with  the  fillet, 
and  forming  the  most  median  layer  of  that  fasciculus.  Spitzka 
has  shown  that  most  probably  this  bundle  contains  the  cerebral 
tracts  of  the  cranial  nerves.  Internal  to  it,  in  the  cut,  emerge 
the  roots  of  the  oculo-motor  nerves.  Shortly  before  their  exit 
they  pass  through  the  pedunculus  corporis  mamillaris. 

We  have  now  only  to  mention  those  symptoms  which  may 
with  reasonable  certainty  be  taken  as  indicating  disease  in  the 
region  of  the  corpora  quadrigemina. 

Lesions  in  the  regio  subthalamica  involve  such  a  tangle  of 
different  sorts  of  fibres  that  their  symptoms  are  of  the  most 
manifold  description.  A  certain  diagnosis  can  hardly  be  made. 
Foci  in  the  vicinity  of  the  pes  pedunculi  involve  the  motor  fibres 
to  the  opposite  side  of  the  body  and  the  neighboring  cranial 
nerves.  Sensory  and  vasomotor  disturbances  may  also  be  present. 
Generally,  not  only  the  muscles  of  the  extremities  and  one  or 
more  of  the  cranial  nerves  are  paralyzed,  but  there  are  also 
present  disturbances  of  the  oculo-motor  nerve  of  the  side  of  the 
lesion.     If  there  is  a  simultaneous  paralysis  of  one  oculo-motor 


THE    SUBTHALAMIC    REGION,    ETC.  125 

nerve  and  of  the  opposite  half  of  the  body  we  may  suspect 
trouble  under  the  corpora  quadrigemina.  Such  patients  have 
either  wholly  or  in  part  lost  control  of  the  limbs  on  one  side  of 
the  body,  the  upper  lid  droops,  the  pupil  is  dilated,  and  the 
whole  eye  turned  outward  by  the  rectus  externus.  The  same 
symptoms  might  come  from  a  tumor  at  the  base  of  the  brain,  as 
is  evident  from  Fig.  57.  It  is,  therefore,  important  for  diagnostic 
purposes  to  know  whether  the  ocular  paralysis  appeared  simul- 
taneously with  the  paralysis  of  the  extremities, — a  condition  ol* 
thhigs  which  could  only  very  rarely  occur  in  the  case  of  a  tumor 
at  the  basis  cerebri.  If  anaesthesia  appear,  it  is  only  present  in 
the  side  opposite  the  disease.  The  sensory  fibres  run  to  a  great 
extent  in  the  lemniscus. 

If  a  disease-centre  extend  farther  dorsad  and  involve  tlie 
corpora  quadrigemina  themselves,  there  appear,  as  may  be  easily 
understood  from  a  glance  at  our  cross-section,  paralyses  of  the 
oculo-motor,  which  may  involve  either  one  or  both  nerves.  In 
disease  of  the  anterior  quadrigeminal  body  there  is  amaurosis; 
in  some  cases  the  ophthalmoscope  reveals  absolutely  nothing. 
In  tumors,  of  course,  as  in  tumors  in  other  regions  of  the  brain, 
we  may  have  choked  disk,  atrophy  of  tlie  optic  nerve,  etc. 
Generally,  the  pupil  does  not  react  either  way.  We  do  not 
know  what  symptoms  are  caused  by  disease  of  the  posterior 
quadrigeminal  body.  Disturbances  of  equilibrium  and  co-ordi- 
nation have  been  observed  in  such  cases. 

We  shall  most  strongly  suspect  disease  of  the  corpora 
quadrigemina  if,  in  cases  of  paralysis  of  the  oculo-motor,  wc- 
can  exclude  peripheral  causes  (on  the  base  of  tlie  brain),  or 
when  only  a  part  of  the  oculo-motor  (for  instance,  the  fibres  to 
tlie  internal  muscles  of  the  eye)  is  injured.  In  affections  of  a 
peri  plieral  origin  this  would  be  impossible ;  such  paralyses  are 
nuclear. 


LECTURE  VIII. 

THE    PONS    AND    THE    CEREBELLUM. 

Gentlemen  :  We  learned  in  the  last  lecture  that  the 
bundles  of  fibres  from  the  fore-  and  inter-  brains  arranged  them- 
selves into  two  layers  in  the  region  of  the  mid-brain.  These 
layers  were  called  the  crusta  or  pes  pedunculi  and  the  tegmen- 
tum. Back  of  tlie  corpora  quadrigemina  the  aqueduct  becomes 
markedly  broader.  Both  pes  and  tegmentum  pass  under  it  and 
farther  back  into  the  liind-brain.  Only  one  division  of  tlie  teg- 
mentum, the  anterior  peduncles  of  the  cerebellum,  arising  in 
the  red  nucleus,  now  passes  dorsad  from  the  floor  of  the  mid- 
brain to  the  roof  of  the  hind-brain.  From  this  roof  has  been 
developed  the  cerebellum  in  adults.  The  space  lying  under  it, 
the  continuation  of  the  aqueduct,  is  called  the  ventriculus 
quartus.  The  prolongations  of  the  crusta  and  tegmentum  are 
contained  in  the  floor  and  lateral  portions  of  the  hind-brain. 

Let  us  first  see  what  becomes  of  the  fibres  of  the  pes.  Not 
far  back  of  the  corpora  quadrigemina  a  thick  mass  of  white 
fibres  is  laid  across  the  crusta.  Arising  from  tlie  cerebellum, 
they  pass  down,  surround,  and  cover  the  region  of  the  pes  in  a 
thick  layer.     Taken  together,  these  fibres  are  called  the  pons. 

Only  a  portion  of  these  fibres  cover  in  the  surface  of  the 
crusta  (stratum  superficiale  pontis)  ;  the  majority  of  them  dip  in 
between  the  fibres  of  the  latter,  and  divide  them  into  isolated 
bands  (stratum  complexum  et  profundum  pontis). 

You  will  remember  that  of  the  fibres  which  pass  downward 
from  the  brain  in  the  crusta  a  part  could  only  be  traced  as  far 
as  the  pons.  They  were  the  fasciculi  from  the  frontal,  parietal, 
and  temporal  lobes.  The  pyramidal  tract  from  the  central  con- 
volutions   passes    tlirough    and    below   tlie  pons.      Almost   the 

(127) 


128 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


whole  inner  and  the  whole  outer  thh'd  of  the  pes  go  no  farther 
than  the  pons.  Below  this  point  only  the  fibres  of  the  middle 
third,  the  pyramidal  tract,  appear.  The  accompanying  figure 
shows  this  and  gives  a  front  view  of  the  pons,  together  with  the 
crura  cerebri  and  the  cerebellum.  The  pyramidal  tract  is 
shaded  dark. 

Fig.  74  shows  in  diagram  the  arrangement  and  course  of 
fibres  in  a  section  through  the  pons.  The  fasciculi  come  from 
above  on  each  side,  out  of  the  cerebellum,  surround  and  pene- 


Fig.  73. 

The  pedunculus  cerebri  and  the  pons  seen  from  in  front.    That  tract  of  the  crusta  which 
does  not  terminate  in  the  pons  is  shaded  dark. 


Hirnschenkel,  Peduncrdus  cerebri. 


Kleinhirn,  Cerebellum. 


Pyramide,  Pyramid. 


träte  the  fibres  of  the  pes,  and,  crossing  over  to  the  opposite  side, 
are  associated  with  the  longitudinal  bundles  of  the  latter.  It  is 
pretty  well  established  that  they  are  connected  with  a  good 
share  of  the  fibres  of  the  pes  and  serve  to  establish  a  communi- 
cation'between  them  and  the  cerebellum.  How  this  is  effected 
is  not  known.  Numerous  ganglion-cells  lie  among  the  fibres 
of  the  pons.  These  are  caught  in  a  fine  net-work  of  medullary 
fibres,  and  to  this  net-work  only  can  the  fibres  of  the  pes  be 
traced  on  the  one  hand,  and  the  fibres  of  the  pons  on  the  other. 
This  much  is  certain,  that  bundles  arise  from  the  region  of 


THE    PONS    AND    THE    CEHEBfXLUM. 


121) 


the  pons  which  pass  at  right  angles  to  those  oi'  tlie  crusta  over 
to  the  opposite  cereheUar  hemisphere. 

Aside  from  this  it  is  not  certain,  and  not  even  prohable, 
that  all  the  fibres  of  the  |)ons  are  to  be  regarded  merely  as  con- 
tinuations of  the  cerebral  fibres.  The  arms  of  the  pons  (brachia 
pontis)  contain  more  fibres  than  are  conveyed  to  it  by  the  crusta. 
Moreover,  many  of  them  acquire  medulkiry  sheaths  at  a  time 


Fig.  74. 
Diagram  of  a  .section  through  the  pons  and  cerebellum. 

Baube,  Tegmentum.     Faseni  aus  tl.  Vorderhirn,  Fibres  from  the  fore-brain. 


when  no  single  fibre  of  the  crusta  is  so  enveloped.  This  con- 
dition I  have  seen  in  cats. 

Although  the  pes  peduncuU  is  pierced  through  and  through 
by  the  fibres  of  tlie  ])ons,  and  in  part  diverted  into  the  cere- 
bellum, yet  tlie  tegmentum  is  continued  through  the  region  of 
the  pons  with  very  little  change.  In  the  last  section  througli 
the  quadrigeminal  region  we  distinguish  the  following  as  the 
principal  structures  of  the  tegmentum  (compare  Fig.  62) : — 

1.  The  gray  substance  around  the  aqueduct,  together  with 
its  nerve-nuclei. 


130 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


2.  Below   it   the    fasciculus   longitudinalis   posterior,  and' 
external  to  this — 

3.  The  fibres  of  the  posterior  commissure. 

4.  The  fibres  from  the  strise  medulläres  thalami. 

5.  The  red  nuclei  in  the  midst  of  the  tegmentum,  and  spring- 
ing from  them  the  superior  or  anterior  cerebellar  peduncles. 

6.  The  lemniscus. 

7.  The  pedunculus  corporis  mamillaris. 

8.  Fibres  from  the  deep  marrow  near  the  median  line. 

9.  Fibres  from  the  stratum  intermedium. 

Before  reaching  the  region  of  the  pons,  the  red  nucleus 

begins  to  diminish  in  size,  the  an- 
terior cerebellar  peduncles  arising 
from  them  pass  more  and  more 
toward  the  periphery,  and  here 
form  two  thick,  white  strands,  which 
lie  between  the  region  of  the  red 
nucleus  and  the  fillet.  In  Fig.  15 
we  see  the  first  traces  of  them  at 
B,  and  in  sections  made  a  little 
farther  back,  but  which  still  pass 
through  the  corpora  quadrigemina, 
they  are  already  found  somewhat 
farther  toward  the  periphery  (Fig. 
76).  In  Fig.  77,  which  represents 
ä  section  through  the  velum  medulläre  posticum,  they  form  the 
outside  margin  of  the  cut.  Soon  after  this  they  pass  into  the 
cerebellum. 

The  region  which  is  left  unoccupied  by  the  disappearance 
of  the  red  nucleus  is  filled  in  by  the  increasing  fibres  of  the  sub- 
stantia reticularis,  which  we  shall  study  later  on. 

The  aqueduct,  as  before  stated,  becomes  expanded  into  the 
fossa  rhomboidalis.  The  gray  matter  surrounding  it  also 
increases  in  area.  A  new  nerve-nucleus,  that  of  the  nervus 
trochlearis,  is  met  with  in  this  region.     Its  fibres,  however,  do 


FKx. 


Commencement  of  the  pons  and 
the  decussation  of  the  cerebellar 
peduncles.  B,  anterior  cerebellar 
peduncles ;  L,  fillet  of  a  newborn 
child.  The  medullary  fibres  of  the 
tegmentum  are  stained  with  hsema- 
toxylin. 


THE    PONS    AND    THE    CEREBELLUM. 


131 


not,  like  those  of  the  oculo-niotor,  pass  backward  through  the 
tegmentum.  They  run  directly  caudad  from  their  point  of 
origin,  then  turn  upward  and  decussate  with  the  corresponding 
fibres  of  the  opposite  side  in  the  velum  medulläre  anticum. 
Thus  they  emerge  from  the  brain  on  its  dorsal  aspect,  just 
behind  the  corpora  quadrigemina.  Portions  of  the  course  of  the 
trochlear  fibres  are  shown  in  Figs.  76  and  77.  According  to 
J  Stilling,  the  nerve  also  receives  a  rootlet  from  the  cerebellum. 
Tlie  whole  course  of  the  nerve,  as  obtained  from  dissections,  is 
shown  in  Fig.  67.     Oculo-motor  fibres  are  no  longer  given  off 


N-tfoehL 


Fig.  76. 


Fig.  77. 


(From  a  newborn  child.    Haematoxylin  stain.) 

Fro.  76.— Section  througli  the  ending  of  the  corpora  quadrigemina.  The  decussation 
of  the  cerebellar  peduncles  almost  completed,  the  red  nucleus  very  small.  Fibres  of  the 
trochlear  nerve  to  be  seen  above. 

Fio.  77.— Section  through  the  velum  medulläre  anticum,  in  which  can  be  seen  the 
trochlear  nerve.  The  red  nucleus  has  disappeared,  the  cerebellar  peduncles  lie  almost 
at  the  periphery.  The  substantia  reticularis  occupies  the  situation  formerly  held  by  the 
red  nucleus.  In  the  pons  is  a  little  fasciculus  or  medullary  fibres.  All  the  rest  of  the 
fibres  of  the  crusta  are  non-medullary,  and  are  only  shown  in  outline. 

at  this  level.  The  posterior  longitudinal  fasciculus  and  the 
stratum  lemnisci,  however,  are  continued  down  to  this  level. 
They  still  occupy  the  same  relative  positions  which  they  did  in 
the  quadrigemiual  region,  as  may  be  seen  by  comparing  Figs. 
72,  75,  76,  and  77.  In  sections  through  the  commencement  of 
the  pons  the  substantia  nigra  has  disappeared  from  view.  Thus 
it  comes  that  the  layer  of  the  fillet  is  no  longer  separated  from 
the  pes,  but  lies  directly  upon  it. 

If  we  have  once  formed  a  clear  idea  of  the  diffbrent  struc- 
tures to  be  se(Mi  in  a  good  section  through  the  quadrigemiual 
region,  we  shall  have  no  difficulty  in  recognizing  and  locating 


132  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

them  in  a  section  through  the  upper  part  of  the  pons.  The 
main  points  of  difference  are  the  changed  position  of  the  cere- 
bellar peduncles  and  the  altered  shape  of  the  gray  matter  under 
the  broadening  aqueduct,  where  new  nerve-nuclei  now  appear. 

In  sections  lower  down,  however,  the  whole  appearance  of 
things  is  changed.  This  comes  from  the  fact  that  the  roof  of 
the  ventricle,  caudad  of  the  velum  medulläre  anticum,  is  devel- 
oped into  the  cerebellum,  and  tliat  fibres  from  both  the  tegmentum 
and  the  crusta  enter  into  intimate  association  with  the  latter. 

The  anterior  peduncles  and  the  fibres  of  the  pons  disappear 
into  the  cerebellum.  From  the  medulla  oblongata  and  the 
spinal  cord  below  come  fibres  which  are  first  interwoven  with 
the  tegmentum  and  then  pass  to  the  cerebellum. 

It  is,  therefore,  better  for  us  to  abandon  temporarily  the 
study  of  the  tegmental  fibres  at  this  point,  just  behind  the 
corpora  quadrigemina,  and  to  turn  our  attention  to  other  parts 
of  the  central  nervous  system,  whose  processes  and  prolonga- 
tions all  meet  just  here.  You  will,  unquestionably,  be  better 
prepared  to  understand  a  section  through  the  tegmentum  after 
you  have  learned  the  arrangement  of  fibres  in  the  cerebellum, 
and  have  obtained  an  insight  into  the  structure  of  the  medulla 
oblongata  and  the  spinal  cord. 

The  cerebellum  consists  of  a  median  portion,  or  "  worm  "" 
(vermis),  and  the  two  hemispheres.  It  is  connected  with  the 
inter-brain  by  its  anterior  peduncles  from  the  red  nuclei,  with 
the  fore-brain  through  the  brachia  pontis, — median  peduncles. 
Through  the  former  it  receives  fibres  from  the  thalamus  and  the 
region  of  the  tegmental  radiation,  through  the  latter  fibres  from 
the  cortex  of  the  frontal,  parietal,  and  temporal  lobes.  A  third 
connection  is  effected  through  the  posterior  peduncles  (corpora 
restiformia,  which  we  shall  consider  later),  with  the  medulla 
oblongata  and  the  spinal  cord.  In  the  accompanying  figure, 
which  shows  the  cerebellum  as  seen  from  above,  we  observe — 

1.  The  situation  with  respect  to  the  corpora  quadrigemina, 
from  beneath  which  the  anterior  peduncles  pass  to  the  cere- 
bellum. 


THE    PONS    AND    THE    CEREBELLUM. 


133 


2.  The  general  form  of  the  organ,  the  vermis  in  the  middle 
and  the  hemispheres  on  eacli  side.  Both  vermis  and  hemispheres 
are  divided  into  several  good-sized  lobes.  Those  of  the  vermis 
are  arranged  around  the  central  white  substance  like  the  fans 
of  a  steam-ship's  screw.  (This  is  shown  in  Fig.  81,  wliich  rep- 
resents a  sagittal  section  through  the  middle  of  the  vermis.) 

The  vermis  is  connected  on  each  side  with  the  white  sub- 
stance of  the  hemispheres,  which  is  divided  into  lobes  by  deep 


Fig.  7«. 

The  cerebelluni.     Dorsal  surface. 

Biwlearm,  Anterior  ceruljellar  podiinclea. 


fissures,  and  into  ridges  by  shallow  ones.  The  dorsal  surface  of 
the  vermis  is  called  the  superior  vermiform  process.  It  is  divided 
into — 

1.  The  lingnla,  far  forward  between  the  anterior  peduncles. 

2.  Tlie  lobulus  (tentralis  (central  lobe).     This  passes  over 
into  the  ala^  lobuli  centralis  on  each  side. 

3.  The  monticulus,  of  which  we  call  the  anterior  portion 
the  culinen  and  the  ])ostorior  portion  tlie  declivity. 


134 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


4,  The  folium  cacuminis,  at  the  posterior  extremity  of  the 
vermis. 

On  the  dorsal  surface  of  the  hemispheres  we  can  distinguish: 

1.  The  anterior  upper  lobe,  also  called  the  lobus  quadran- 
gularis,  on  each  side  of  the  monticulus.  In  front  of  it  are  the 
alse  lobuli  centralis. 

2.  The  posterior  upper  lobe  (lobus  semilunaris  superior). 
Both  posterior  upper  lobes  are  connected  by  the  folium  cacumi- 
nis. The  following  cut  shows  the  lobes  of  the  under  surface  of 
the  cerebellum.    It  presents  a  somewhat  complicated  appearance. 


Fig.  79. 
The  cerebellum.    Ventral  surface. 

Binde  A.,  Anterior  cerebellar  peduncles. 

In  order  to  obtain  a  good  view  we  must  first  sever  the  connec- 
tions of  the  cerebellum  with  the  mid-brain,  the  pons,  and  the 
medulla  oblongata.  Thus,  on  each  side  are  the  three  cut  sur- 
faces of  the  three  cerebellar  peduncles.  Between  the  anterior 
peduncles  lies  a  thin  membrane,  the  velum  medulläre  anticum, 
which  is  a  part  of  the  roof  of  the  hind-brain.  It  is  shown  cut 
through  in  the  figure. 

The  lobes  on  the  under  surface  of  the  vermis  are  called — 

1.  The  nodulus. 

2.  The  uvula. 


THE    PONS    AND    THE   CEREBELLUM. 


135 


3.  The  pyramis  (pyramid). 

4.  Tuber  valvulae,  far  back,  and  extending  partly  over  on 
the  dorsal  surface. 

In  the  hemispheres  lie — 

1.  The  flocculus,  on  each  side  of  the  nodulus. 

2.  The  tonsilla,  on  each  side  of  the  uvula. 

.     3.  External  to  the  last  mentioned,  the  lobus  cuneiformis. 
4.  Behind  this,  the   posterior  lower   lobe,  lobus  posterior 
inferior.     Its  anterior  part  is  called  the  lobus  gracilis  and  its 
posterior  part  the  lobus  semilunaris  inferior. 


Fig.  80. 
The  three  peduncles  arising  in  the  mid-brain,  the  pons,  and  the  spinal  cord,  and  pass- 
ine  into  the  .erebellnin.  Afier  Hirs.hfcld  and  Leveille  (Sappey)  p:merKing  from 
heiif-atli  the  corpora  <iuadriKemina  (8)  can  be  seen  the  superior  cerebellar  peduncles  (5)  ; 
from  the  ventral  surlace  come  the  middle  peduncles  or  arms  of  the  pons  (7),  and  trom 
the  spinal  cord  ascend  tlie  restiform  bodies  or  inferior  peduncles  (3).  ( )n  entering  they 
decussate  witli  the  superior  jiedunctles  Notice,  too,  the  form  of  the  rhomboidal  fossa  (1). 
the  Striae  acusticie  (2),  the  clavai  of  the  funiculi  gracilis  (4).    At  6  is  the  fillet. 

In  the  above  cut  you  see  the  three  bundles  of  medullary 
fibres  just  mentioned  passing  to  the  cerebellum  on  each  side. 
These  extend  to  the  central  wliitc  substance  of  tlie  hemispheres, 
and  this  in  turn  is  continued  into  the  medulla  of  the  lobules 
and  ridges.  These  ridges  are  covered  witli  a  gray  cortex,  which 
follows  closely  all  the;  elevations  and  depressions  of  tlie  surface, 
so  that  its  extent  is  relatively  much  greater  than  would  be  sup- 
posed from  the  size  and  shape  of  the  cerebellum. 


136  LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 

In  the  hemispheres  the  white  substance  is  rather  plentiful  ; 
but  in  the  vermis  it  is  scanty.  The  accompanying  sagittal  section 
(Fig.  81)  through  the  cerebellum  passes  directly  through  the 
vermis.  It  shows  the  white  substance  of  the  latter  prolonged 
anteriorly  into  a  thin  membrane,  the  velum  medullary  anticum, 
which  extends  toward  the  corpora  quadrigemina.  This  thin 
membrane,  spread  out  between  the  anterior  peduncles  of  the 
cerebellum,  marks  tlie  point  where  the  roof  of  the  mid-brain  is 
continuous  with  the  roof  of  the  hind-brain.  Upon  it  lies  the 
most  anterior  lobule  of  the  cerebellum, — the  lingula. 

The  peculiar  appearance  presented  by  a  sagittal  section  of 


Fig.  81. 

Sagittal  section  through  the  middle  of  the  vermis. 

Vert.  A.,  Vertical  branch.  Horiz.  A.,  Horizontal  branch. 

the  vermis  gave  rise  to  its  ancient  name,  the  arbor  vitse.  The 
central  mass  of  white  matter  is  called  the  corpus  trapezoides. 
The  lingula,  lobus  centralis,  uvula,  and  nodulus  all  communicate 
separately  with  it.  A  number  of  the  lobes  of  the  monticulus 
have  a  common  connection  with  the  corpus  trapezoides,  and 
form  the  vertical  branch  of  the  arbor  vitse.  The  posterior  portion 
of  the  monticulus,  the  folium  cacuminis,  and  the  tuber  valvulae 
— that  is  to  say,  the  lobes  situated  at  the  posterior  edge  of  the 
cerebellum — form  the  horizontal  branch  of  the  arbor  vitse. 

Posteriorly,  the  velum  medulläre  posticum  passes  out  from 
the  cerebellum,  forms  the  roof  of  the  fossa  rhomboidalis,  and  is 


THE    PONS    AND    THE    CEREBELLUM. 


137 


continued  on  to  the  termination  of  the  posterior  columns  of  the 
spinal  cord. 

The  lateral  portions  of  this  roof  are  composed  of  a  thickish 
(principally  glia)  tissue;  in  the  middle  line  it  is  nothing  but  a 
thin  layer  of  cuboidal  epithelium.     Numerous  blood-vessels  from 


Fig.  82. 

Section  through  the  cortical  layer  of  tlie  cerebellum.    H;ematoxylin  staining. 
Diagranuiiatic  below  and  to  the  right. 


Kö)-ner»rMclU,  Granular  layer.       Mnrhleinte,  Medullar/  layer.       Fnrkiiijc'mhe  Zelle,  Cells  of  Purkinje. 
RiiiilK.  Cortex. 


Ilary  layer.       FurkiuJ<:'/«:Ite  . 
Sc/innn,  Diagrammatic. 


the  pia  are  distributed  through  it,  and  crowd  it  partly  down  into 
the  ventricle  (plexus  choroideus  vcntriculi  quarti  medialis). 
Opposite  the  medulla  oblongata,  its  lateral  portion  forms  a  sort 
of  sac,  which  is  filled  with  vascular  loops  and  is  called  the 
plexus  choroideus  lateralis  (see  Fig.  120).    In  the  middle  choroid 


138  LECTURES   ON    THE   CENTRAL   NERVOUS    SYSTEM. 

plexus,  as  well  as  near  the  point  of  origin  of  the  lateral  ones 
there  are  some  minute  perforations  (Key  and  Retzius).  The 
middle  one  of  these  foramina  in  the  medullary  tube  is  called 
the  foramen  of  Magendie,  It  is  of  great  importance  in  obvi- 
ating sudden  changes  of  pressure  in  the  cerebro-spinal  fluid. 

Into  the  above-described  mass  of  the  cerebellum  pass  the 
three  pedunculi  on  each  side.  They  pass  into  the  large  central 
mass  of  white  substance,  and  from  there  become  united  with 
gray  nuclei  and  send  fasciculi  to  the  cerebellar  cortex. 

Little  is  known  as  to  the  connections  and  course  of  these 
cerebellar  fibres.  We  know  that  they  pass  from  the  central 
white  substance  through  a  granular  layer  containing  nerve  and 
glia  cells,  that  they  extend  beyond  this  and  enter  some  peculiar, 
large,  branched  cells, — the  ganglion-cells  of  Purkinje  ;  that  the 
processes  of  these  latter  bodies  repeatedly  divide  and  pass  to 
regions  just  under  the  surface  of  the  cerebellum.  Apparently 
these  processes  enter  into  some  sort  of  relation  with  a  net-work 
of  horizontal  and  oblique  fibres  situated  in  this  part  bf  the 
cortex.  These  bend  around  and  pass  back  through  the  granular 
layer  to  the  white  substance  after  anastomosing  and  interweav- 
ing freely  with  each  other.  A  general  jdea  of  their  course  may 
be  obtained  from  the  dark  lines  in  the  accompanying  figure. 
Many  more  fibres  return  from  the  cortex  than  pass  to  its  large 
cells, — a  fact  which  can  be  explained  by  the  ramifications  of  its 
cell-processes.  All  parts  of  the  cortex  are  connected  with  each 
other  by  peculiar  garlanded  bundles  of  fibres,  which  closely 
follow  the  cortical  elevations  and  depressions. 

The  cerebellum  also  presents  collections  of  gray  matter 
aside  from  that  in  the  cortex.  On  each  side,  in  the  midst  of  the 
white  substance  of  the  hemispheres,  there  lies  a  large  convoluted 
nucleus, — the  corpus  ciliare  or  corpus  dentatum.  Internal  to  it 
other  collections  of  gray  matter  are  met  with;  first,  the  embolus, 
then  the  nucleus  globosus,  a  longish  nucleus  with  a  tuberosity 
at  its  posterior  extremity;  and  lastly,  lying  farthest  inward,  is  the 
nucleus  tegmenti  (nucleus  fastigii). 


THE    PONS    AND    THE    CEREBELLUM. 


139 


These  nuclei  are  best  shown  in  an  almost  horizontal  section 
through  the  cerebellum,  such  as  is  represented  in  Fig.  83,  taken 
from  B.  Stilling's  atlas.     In  such  a  section  you  will  observe  in 


the  centre  the  white  substance  of  the  vermis  and  the  nucleus 
tegmenti,  and  in  Iront  of  these  some  lasciculi  of  d(;cussating 
fibres,  the  anterior  decussating  commissure.  To  the  right  and 
left  lie  the  white  substance  of  the  hemispheres,  inclosing  the 


uo 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


nucleus  globosus,  the  embolus,  and  external  to  these  the  plicated 
medullary  lamma  of  the  nucleus  dentatus.  The  deep  indenta- 
tions in  the  suriace  mark  the  position  of  the  fissures  between  the 
lobes.  Between  the  anterior  peduncles  {R  R)  lies,  as  I  before 
stated,  the  lingula  on  the  velum  medulläre  anticum :  it  is  also 
cut  through  in  a  horizontal  direction  {Ä). 

All  the  nuclei  which  you  see  in  the  white  substance  are 
connected  with  each  other  by  bands  of  gray  matter.  Their 
relations  to  the  fibres  of  the  white  substance  are  almost  totally 


Fig.  84. 

Section  jnst  in  front  of  the  eulmeii.  passing  in  a  frontal  direction  through  the 
cerebellum.  U*,  fourth  ventricle.  R,  superior  cerebellar  peduncle.  P,  pons.  Zon, 
decussational  zone;  internal  to  it  lie  the  fibres  of  the  fleece.  Cr,  bundles  from  the 
restiform  body  pass  over  into  the  fibrse  semicirculares,  Sem.  S,  region  of  exit  of  root 
of  trigeminus.     (After  B.  fetilling.) 

unknown.  If  a  frontal  section  is  made  just  in  front  of  the 
point  where  the  peduncles  enter  the  cerebellum,  then  dorsad  of 
its  plane  will  be  the  cerebellum,  and  ventrad  of  it  will  be  the 
pons  and  the  fibres  which  pass  from  it  on  both  sides  into  the 
hemispheres.  Between  the  cerebellum  and  the  tegmentum  lies 
the  fourth  ventricle,  bounded  on  each  side  by  the  divided  pe- 
duncles. This  is  the  continuation  of  the  aqueduct  of  Sylvius. 
The  white  substance  of  the  vermis  does  not  fall  into  the  plane 


THE  PONS  AND  THE  CEREBELLUM. 


141 


of  this  section.  The  tegmentum  and  the  crusta,  the  latter  per- 
forated by  the  fibres  of  the  pons,  are  arranged  just  as  we  saw 
them  in  sections  through  the  quadrigeminal  region. 

A  ffood  many  of  tlie  bands  of  fibres  shown  in  the  accom- 
panying  cut  have  not  yet  been  described,  because  we  have  had 
no  opportunity  to  consider  the  system 'of  fibres  peculiar  to  the 


Fig.  8.5. 
Diagram  of  the  course  of  fibres  in  the  cerebellum  to  explain  the  ongin  of  the  cere- 
bellar peduncles.     Notice  that  thev  are  composeii  of  intra-ciliary,  extra-ciliary,  and 
hemisphere  fibre.s.  This  shown  with  peculiar  distinctness  in  the  right  superior  peduncle. 


Dend.  Ffw.rn,  Dendritic  tracts. 

DirecU  Seiii.  Balm,  Direct  sensory  tract. 

Haulie,  Tegmentum. 


KMnh-Seitetmlranq-Buhn,  Lateral  cerebellar  tract. 
Kreuzimgs-zonen,  Zone  of  decussation. 
VliesK,  The  fleece. 


cerebelhim.  We  have  seen  tliat  fibres  pass  through  the  three 
pechincles  into  the  cerebellum  ;  our  knowledge  of  tlieir  course 
is  still  very  unsatisfactory,  notwithstanding  the  fact  that  that 
most  skillful  investigator,  Benedikt  Stilling,  was  for  years  occu- 
pied in  the  study  of  this  region.  The  diagram  (Fig.  85)  will, 
in  the  simplest  manner  possible,  give  Stilling's  views  as  to  tlie 
most  important  tracts  of  fibres.*     It  represents  a  frontal  section 

♦  The  fibres  of  the  restiforia  bodies  are  given  according  to  my  own  investigations,  some- 
what modified. 


142  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

somewhat  farther  forward  than  the  one  given  in  Fig.  84.  In 
order  to  simphfy  matters  the  anterior  peduncles  are  represented 
as  occupying  a  wrong  position,  as  may  be  seen  by  comparison 
with  Fig.  84.  They  ought  to  be  shown  lying  close  over  the 
ventricle. 

The  first  thing  to  attract  our  notice  is  that  the  different 
parts  of  the  cortex  are  connected  by  curved  fibres,  fibrse  arci- 
formes.  From  all  points  of  the  cortex  fibres  arise,  which, 
diverging  from  each  other  like  the  limbs  of  a  tree,  pass  into  the 
white  substance.  They  are  called  the  Dendritic  tracts.  Before 
they  reach  the  corpus  dentatum  they  are  lost  in  a  thick  tangle 
of  fibres.  Several  zones  of  these  tangled  fibres  can  be  distin- 
guished, and,  from  the  fact  that  a  true  decussation  can  be  made 
out  in  them,  they  have  received  the  name  of  decussating  zones. 
External  to  the  ciliary  body  is  a  mass  of  fibres  converging 
toward  it,  which  in  part  enter  the  gray  matter  and  in  part  pass 
through  it.  This  mass  of  fibres,  on  account  of  its  resemblance 
to  wool,  is  called  the  fleece. 

The  anterior  peduncles  enter  the  ciliary  body  and  break  up 
into  a  net-work  of  fibres.  This  net-work  (intra-ciliary  fibres) 
is  connected,  either  directly  or  by  means  of  ganglion-cells,  with 
the  before-mentioned  tangle  of  fibres,  the  fleece  (extra-ciliary 
fibres).  Fibres  pass  from  this  intra-ciliary  net-work  to  the 
anterior  peduncles,  and  to  it  from  the  cortex  of  the  hemispheres. 
The  anterior  peduncles,  therefore,  are  composed  of  (1)  intra- 
ciliary  fibres  (the  majority  of  fibres  composing  them)  ;  (2)  extra- 
ciliary  fibres  ;  (3)  fibres  from  the  hemispheres.  The  last  two  of 
these  are  only  present  in  small  quantity. 

The  restiform  bodies  have  their  origin,  to  a  great  extent,  in 
the  fleece,  and,  therefore,  consist  chiefly  of  extra-ciliary  fibres. 
Those  fibres,  however,  which  pass  through  the  central  portion 
of  the  restiform  bodies,  and  which  originate  mainly  in  the  spinal 
cord,  pass,  in  part,  directly  to  the  dorsal  cortex  of  the  vermis, 
and  in  part  pass  around  the  corpus  dentatum  from  without  in- 
ward, and  extend  over  to   the  ventral  portion  of  the  vermis, 


THE  PONS  AND  THE  CEREBELLUM.  143 

where  they  are  lost  between  the  two  nuclei  globosi.  These 
fibres  receive  tlieir  medullary  covering  as  early  as  the  seventh 
fcetal  month.  Another  band  of  fibres,  which  becomes  medullary 
at  a  later  period  than  the  last  mentioned,  but  still  far  in  advance 
of  the  bulk  of  the  restiform  fibres,  arises  in  the  vicinity  of  the 
nucleus  globosus  and  passes  to  the  outer  wall  of  the  fourth 
\  entricle  median  to  the  posterior  peduncles.  Its  most  anterior 
fibres  make  their  exit  from  the  brain  along  with  the  trigeminal 
nerve,  others  pass  off"  with  the  acoustic,  and  still  others  run 
caudad.  The  latter  become  still  fewer  in  the  oblongata,  ap- 
parently because  some  of  them  enter  the  roots  of  the  glosso- 
pharyngeal and  vagus.  Still,  this  fasciculus  can  be  traced  in 
cross-section  to  the  termination  of  the  posterior  columns  of  the 
cord.  The  whole  tract  is  called  the  direct  sensory  tract  of  the 
cerebellum.  I  shall  have  occasion  later  to  show  it  to  you  in 
several  illustrations.  To-day  I  will  call  your  attention  to  a  sec- 
tion through  the  brain  of  a  seven  months'  foetus,  in  which  you 
will  recognize  that  portion  of  the  tract  which  passes  into  the 
trigeminus  (Fig.  86). 

Lastly,  it  should  be  stated  that  fibres  pass  directly  from  the 
hemispheres  to  the  restiform  bodies. 

The  arms  pf  the  pons  can  be  traced  far  into  the  correspond- 
ing hemispheres  (hemisphere  fibres).  Near  the  cortex  they  are 
lost  in  the  dense  tangle  of  fibres.  They  receive,  however,  fibres 
from  the  fleece  (extra-ciliary  fibres). 

In  recapitulation  we  shall  find  that  the  anterior  peduncles 
are  composed  mainly  of  intra-ciliary  fibres,  the  middle  peduncles 
largely  of  hemisphere  fibres,  and  the  posterior  peduncles  chiefly 
of  extra-ciliary  fibres  and  fibres  from  the  roof  of  the  vermis. 
I^iit  each  peduncle  receives  auxiliary  bands  from  the  point  of 
origin  of  each  of  the  other  peduncles. 

The  anterior  jx'duncle  and  the  restiform  body  also  receive 
an  addition  from  the  white  substance  of  the  vermis. 

There  is  a  point  in  the  anterior  part  of  the  white  substance 
of  the  vermis  wlu^re  many  fibres  decussate, — the  anterior  decus- 


144 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


sating  commissure.  These  fibres  come  from  the  anterior 
lobules,  decussate  in  front  of  the  nucleus  tegmenti,  and  pass  to 
the  opposite  side  of  the  cerebellum.  From  here  they  can  be 
traced   into   the   anterior  peduncles  and  the  restiform  bodies. 

Cerebellum 


Frontal  section  through  the  cerebellum  and  pons  of  an  embrj'o  of  26  weeks.    All  the 
meuullary  fibres  are  stained  with  haematoxylin. 


Aus  dem,  Corpu 


■iti/'..  From  the  restiform  body. 

Schleife,  Fillet. 


Bindearm,  Anterior  cerebellar  peduncle. 


The  fibres  of  the  posterior  lobules  follow  an  exactly  analogous 
course,  and  form  the  posterior  decussating  commissure  in  the 
back  part  of  the  white  substance  of  the  vermis. 

In  the  midst  of  the  white  substance  between  the  two  com- 
missures lies  the  nucleus  fastigii  (nucleus  tegmenti),  surrounded 


THE    PONS    AND    THE    CEREBELLUM.  145 

and  covered  in  by  fibres  which,  originating  in  the  liorizontal 
branch  of  the  arbor  vitse,  connect  the  two  decussating  commis- 
sures, and  in  part  pass  off  to  the  cerebellar  hemispheres  with 
the  fibres  of  the  anterior  of  these  commissures.  The  nuclei 
tegmenti  are  connected  with  all  these  fibres. 

The  external  surface  of  the  cerebellum  was  described  by  Malacarne,  Reil, 
and  Burdach,  just  as  it  is  described  to-day.  Investigations  of  its  internal  struc- 
t-ure  were  undertaken  by  F.  Arnold,  Reil,  Kölliker,  Meynert,  and  particularly  by 
B.  Stilling.  Later  researches  as  to  the  structure  of  the  peduncles  have  been  made 
by  Bechterew,  Marchi,  and  the  author.  A  whole  literature  has  been  written  on 
the  cortex  of  the  cerebellum,  among  the  contributors  to  which  are  Purkinje, 
Gerlach,  Hess,  Kölliker,  Fee,  Schultze,  Obersteiner,  Beevor,  and  Golgi. 

Diseases  of  the  cerebellar  peduncles  alone  are  very  seldom 
observed.  For  this  reason  we  are  not  familiar  with  the  symp- 
toms which  would  be  caused  by  them.  Gradual  destruction  of 
one  brachium  pontis  may,  apparently,  give  rise  to  no  symptoms. 
Diseases  which  cause  irritation  (htemorrhage,  for  example)  may 
bring  about  forced  movements,  generally  of  a  rolling  nature, 
now  toward  the  affected  side,  and  now  toward  the  sound  one. 
A  forced  position  of  the  trunk  or  of  the  head  only,  with  or  with- 
out nystagmus,  has  been  observed  in  irritating  diseases  of  one  of 
the  peduncles. 

Diseases  of  the  cerebellum  may,  on  account  of  the  inti- 
mate association  with  and  proximity  of  the  complex  tracts  of 
fibres  lying  in  the  crura  cerebri,  the  pons,  and  the  medulla  ob- 
longata, give  rise  to  symptoms  which  cannot  be  attributed  to  the 
cerebellum.  In  cases  where  only  actual  cerebellar  substance  is 
diseased,  we  find  vertigo,  headache,  vomiting,  uncertainty  of  gait 
(ataxy),  and  vague  feelings  of  weakness  in  the  extremities,  both 
'of  the  same  and  the  op])Osite  side.  Ileal  paralysis  and  sensory 
disturbances  are  wanting.  Occasionally,  vision  is  seriously 
affected ;  still,  it'  is  difficult  to  say  how  far  this  may  depend  on 
a  participation  of  the  visual  centres  near  by.  Mental  disturb- 
ances often  appear  in  disease  of  the  cerebellum.  Inasmuch  as 
many  diseases  of  the  cerebellum  present  no  symptoms,  and  none 
of  the  symptoms  al)ovc  enumerated  are  caused  exclusively  by 

,      10 


146  LECTURES   ON    THE    CENTRAL    NERVOUS    SYSTEM. 

cerebellar  lesions,  a  diagnosis  is  very  difficult,  and,  as  a  rule, 
uncertain.  It  is  usually  of  great  importance  to  take  into  con- 
sideration the  symptoms  arising  from  neighboring  organs 
(paralysis  oi  the  oculo-motor,  for  instance). 

It  seems  to  be  a  fact  that  the  diseases  which  attack  the 
vermis  are  the  ones  which  give  rise  to  ataxy  and  vertigo. 

Most  of  those  symptoms  which  are  regarded  as  charac- 
teristic of  cerebellar  disease  only  appear  when  the  anterior  or 
median  peduncles,  or  the  floor  of  the  fossa  rhomboidalis,  or  the 
quadrigeminal  region  are  involved,  either  directly  or  indirectly. 


LECTURE  IX. 

THE    ROOTS    OF    THE    PERIPHERAL    NERVES,   THE    SPINAL    GANGLIA, 
AND    THE    SPINAL    CORD 

Gentlemen:  The  peripheral  nerves  are  made  up,  as  you 
know,  of  botli  motor  and  sensory  fibres.  In  the  vicinity  of  the 
spinal  cord  these  fibres  are  separated.  The  branch  containing 
the  motor  fibres  passes  directly  into  the  spinal  cord  as  an 
anterior  root.      The  sensory  fibres  pass  into  the  spinal  ganglion. 

Situated  in  tlie  sj)inal  ganglia  are  a  number  of  large  mono- 
polar cells  (occasionally  bipolar).  In  the  case  of  a  monopolar 
cell  the  process  generally  divides  shortly  after  leaving  it,  so  that 
liere  also  we  have  two  processes. 

Your  attention  was  called  to  these  two  processes  of  the 
cells  of  the  spinal  ganglia  in  the  second  lecture.  You  Avill 
recollect  that,  according  to  the  observations  of  His,  the  sensory 
nerves  are  evolved  from  cells  in  the  form  of  a  process  extending 
toward  the  periphery,  and  that  tlicse  cells  also  send  out  another 
fibre  toward  the  spinal  cord  which  forms  the  posterior  root. 

Since  the  careful  examination  made  on  adults  shows  that 
about  as  many  fibres  pass  through  the  posterior  root  to  the 
spinal  cord  as  have  entered  tlie  ganglion  from  the  nerves,  it 
would  seem  as  though  a  single  cell  were  intercalated  in  the 
course  of  each  fibre. 

It  is,  however,  a  matter  of  great  importance  to  determine 
whether  all  sensory  nerves  originate  in  the  cells  of  tlie  spinal 
ganglia.  This  question  has  been  fully  settled  by  the  experi- 
mcMts  of  Waller  and  others,  and  by  the  most  recent  experiments 
of  Joseph. 

Every  nerve-fibre  which  is  divided  from  its  mother-cell  de- 
generates.    If  a  sensory  iK^rve  is  divided  just  in  front  of  the 

(147) 


148 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM, 


spinal  ganglion  all  its  fibres  degenerate.  The  ganglion  itself 
and  the  root  originating  in  it  remain  normal.  This  shows  that 
the  cut  has  severed  all  the  fibres  from  their  cells.  If  we  cut  the 
posterior  root  just  back  of  the  ganglion,  only  a  few  fibres  of  the 
sensory  nerve  become  degenerated  and  the  majority  remain 
intact.  The  nerve  must,  therefore,  consist  of  fibres  which 
originate  in  the  spinal  ganglion-cells,  for  the  connection  be- 
tween these  is  unbroken.  The  -fibres  which  were  destroyed 
must  have  come  from  the  spinal  cord  itself,  for  they  are  only 
severed  from  the  latter  and  not  at  all  n 


Hint,  Wi^r^ef. 
Sp'inal^ngliaO^ 


-hier   Nerv. 


Fig.  87. 
Diagram  of  the  relations  of  the  nerve-roots 

to  the  spinal  cord. 

Gemischter  Nerv.,  Mixed  nprve.    Hint.  Wurzel,  Post.  root. 

Mot.  fheil.  Motor  part.  Sens.  Theil,  Sensory  part. 

Vordere  Wurzel,  Ant.  root. 


Fig.  I 

Diagram  of  the  flhres  of  a  spinal 

ganglion. 

Hint.  Wurzel,  Post.  root. 


from  the  ganglion.  An  examination  of  the  root  after  this  latter 
experiment  will  account  for  this.  The  root  is  divided  from  the 
g-anglion,  and  we  find  that  only  a  few  fibres  have  remained 
sound:  the  majority  have  been  destroyed.  The  fibres  which 
i^main  uninjured  must  have  their  source  in  the  spinal  cord,  for 
they  are  connected  to  it  alone;  the  fibres  which  perish  must 
come  from  the  spinal  ganglion,  for  their  connection  with  it  alone 
was  severed. 

Experiments  show  that  cell-processes  pass  out  of  the  gan- 


THE    HOOTS    OF    THE    PERIPHERAL    NERVES,    ETC. 


149 


glion  in  two  directions, 
and  that  fibres  which 
originate  in  the  spinal 
cord  only  pass  through 
it.  We  may,  therefore, 
consider  the  relations  of 
the  sensory  roots  to  tlie 
spinal  ganglia  to  be  as 
represented  in  the  dia- 
gram. Fig.  88. 

Between  the  spinal 
ganglion  and  the  cord 
the  sensory  and  motor 
roots  divide  into  a  num- 
ber of  root-fibres,  which 
for  some  considerable 
distance  enter  the  spinal 
^ord,  the  sensory  fibres 
on  the  dorsal  aspect, 
and  the  motor  fibres  on 
tlie  ventral  surface,  in 
a  jjroove  situated  some- 
what  laterally.  The 
number  of  these  root- 
fibres  is  not  alike  for 
all  roots,  and  differs  in 
different  individuals. 

Recent  investiga- 
tions show  that  each 
root  does  not  corre- 
spond to  one  definite 
peripheral  nerve.  It  has 
been  proved  that  in 
each  peripheral  nerve 
there  is  containcKl  a 
large  number  ol'  nerve- 
fibres  from  different 
roots,    and    it    is    very 


150  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

probable  that  two  muscles  which  are  commonly  associated  in 
co-ordinate  movements  are  innervated  by  the  same  root,  even 
though  they  may  be  supplied  by  diiFerent  nerves. 

The  interchange  of  fibres  which  makes  this  possible  takes 
place  partly  in  the  plexus  (cervical,  lumbar,  etc.)  and  partly  in 
the  larger  nerve-trunks,  which  are  themselves  to  be  regarded  as 
a  sort  of  plexus. 

Only  few  cases  of  disease  of  the  spinal  ganglia  are  known.  Besides  acute 
pain,  an  intercostal  herpes  zoster  extending  along  the  course  of  the  affected 
nerves  has  been  taken  as  a  symptom  of  this  trouble.  It  is  questionable,  however, 
whether  this  should  be  referred  to  the  ganglionic  apparatus,  for  we  have  herpes 
zoster  without  disease  of  the  ganglia,  and,  furthermore,  herpes  zoster  has  been 
found  to  follow  inflammation  of  the  peripheral  nerves. 

The  roots,  therefore,  enter  the  spinal  cord'  along  its  whole 
length.  The  latter  becomes  somewhat  thickened  at  those  points 
where  the  largest  roots  enter  it  from  the  extremities.  The  cer- 
vical enlargement  receives  the  nerves  of  the  arms,  and  the  lumbar 
enlargement  those  of  the  leg.  The  intercostal  nerves  arise  from"^ 
the  narrowest  part  of  the  spinal  cord.  The  lowest,  club-shaped, 
portion  is  called  the  conns  terminalis :  from  it  there  arise  not  only 
the  nerves  but  a  long,  thin  prolongation, — the  filum  terminale. 

The  upper  boundary  of  the  cord  is  formed  by  the  commence- 
ment of  the  decussation  of  the  pyramidal  tract  (of  which,  later). 

It  is  often  an  important  diagnostic  point  at  the  bedside  to 
determine  the  level  at  which  those  nerves  arise  which  supply 
certain  paralyzed  muscles  or  anaesthetic  regions  of  the  skin. 

The  effort  has  been  made  to  settle  this  question  by  experi- 
ments on  animals,  for  the  simple  anatomical  method  would 
never  suffice.  The  attempt  has  repeatedly  been  made  to  sum- 
marize those  local  injuries  to  the  cord  in  human  beings  (com- 
pressions, haemorrhages,  etc.)  which  give  rise  to  definite  disturb- 
ances and  utilize  the  results  to  settle  this  question. 

I  give  you  herewith  the  results  attained  by  Starr  in  this 
manner,  who  made  a  comparative  study  of  all  the  cases  he  could 
obtain,  in  1888.  In  all  probability,  further  researches  will  lead 
to  minor  corrections. 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC. 


151 


LOCALIZATION    OF   FUNCTION    IN    THE    DIFFERENT    SEGMENTS   OF    THE 

SPINAL    CORD. 


Segment. 

Muscles. 

Reflexes. 

Sensation. 

2d  and  3d  Cer- 

Stemo-mastoid. 

Hypochondiium(?).          Back  of  head  to  vertex. 

vical. 

Trapezius. 

Sudden  inspiration  pro-    Neck. 

Scaleiii  and  neck. 

duced  by  sudden  pres- 

Diaphragm. 

sure    beneath    lower 
border  of  ribs. 

4th  Cervical. 

Diaphragm. 

Pupil.    4th  to  7th  cerv.    Neck. 

Deltoid. 

Dilatation  of  the  pupil    Upper  shoulder. 

Biceps.  Coraco-brachialis. 

produced    by    irrita- 

Outer arm. 

Supinator  longus. 

tion  of  neck. 

Rhomboid. 

Supra-  and  infra- spinatus. 

5th  Cervical. 

Deltoid. 

Scapular. 

Back  of  shoulder  and 

Biceps.  Coraco-brachialis. 

5th  cervical  to  1st  dorsal 

arm. 

Brachialis  anticus. 

Irritation  of  skin  over 

Outer  side  of  arm  and 

Supinator  longus. 

the  scapula  produces        forearm. 

Supinator  brevis. 

contraction     of     the    Anterior     upper     two- 

Deep  muscles  of  shoulder- 

scapular  muscles. 

thirds  of  arm. 

blade 

Supinator  longus. 

Rhomboid.    Teres  minor. 

Tapping  its  tendon  in 

Pectoralis  (elav.  part). 

wrist  produces  flexion 

Serratus  maguus. 

of  forearm. 

6th  Cervical. 

Biceps.  Brachialis  anticus. 

Triceps. 

Outer  side  of  arm  and 

Pectoralis  (clav.  part). 

.'jth  to  6th  cervical. 

forearm. 

Serratus  magnus. 

Tapping   elbow-tendon 

Inside     and    front    of 

Triceps. 

.  produces  extension  of 

forearm. 

Extensors    of    wrist   and 

forearm. 

fingers. 

Posterior  wrist. 

Pronators. 

6th  to  8th  cervical. 
Tapping  tendons  causes 
extension  of  hand. 

7th  Cervical. 

Triceps  (long  head). 

Anterior  wrist. 

Inner  and  back  of  arm 

Extensors    of    wrist    and 

7th  to  8th  cervical. 

and  forearm. 

fingers. 

Tapping   anterior    ten- 

Radial  distribution  in 

Pronators  of  wrist. 

don  causes  flexion  ot 

the  hand. 

Flexois  of  wrist. 

wrist. 

Subscapular. 

Palmar.  7th  cervical  to 

Pectoralis  (costal  part). 

1st  dorsal. 

Latissimus  dorsi. 

Stroking    palm    causes 

Teres  major. 

closure  of  fingers. 

8th  Cervical. 

Flexors     of     wrist     and 

Forearm     and     hand  ; 

fingers. 

median     and     ulnar 

Intrinsic  muscles  of  hand. 

areas. 

let  Dorsal. 

Extensors  of  thumb. 

Ulnar    distribution    to 

Intrinsic  hand-muscles. 

hand. 

Thenar    and    hypothenar 

eminences. 

2d    and    12th 

Muscles  of  back  and  ab- 

Epigastric.   4tli  to  7th 

Skin  of  chest  and  abdo- 

Dorsal. 

domen. 

dorsal. 

men,  in    bands  run- 

Erectores splnae. 

Tickling  mammary  re- 

ning     around     and 

gion  causes  retraction 

downward         corre- 

of the  (epigastrium. 

sponding     to    spinal 

% 

Abdominal.  7tli  to  11th 

nerves. 

dorsal. 

Upper  gluteal  region. 

Stroking  side  of  abdo- 

men causes  retraction 

of  belly. 

152  LECTURES   ON    THE   CENTRAL    NERVOUS    SYSTEM. 

LOCALIZATION  OF  FUNCTION  {continued). 


Segment, 

Muscles. 

Reflexes. 

Sensation. 

let  Lumbar. 

nio-psoas. 
Sartorius. 

Cremasteric.    1st  to  3d 

lumbar. 
Stroking    inner    thigh 

causes    retraction  of 

scrotum. 

Skin   over    groin    and 
front  of  scrotum. 

3d  Lumbar. 

Ilio-psoas.     Sartorius. 
Flexors  of  knee  (Remak) . 
Quadriceps  femoris. 

Patella  tendon. 
Striking  tendon  causes 
extension  of  leg. 

Outer  side  of  thigh. 

8d  Lumbar. 

Quadriceps  femoris. 
Inner  rotators  of  thigh. 
Abductoi-s  of  thigh. 

Bladder  centre. 
2d  to  4th  lumbar. 

Front  of  thigh. 

4th  Lumbar. 

Abductors  of  thigh. 
Adductors  of  thigh. 
Flexors  of  knee  (Fei-rier). 
Tibialis  anticus. 
Peroneus  longus. 

Rectal  centre. 

4th  lumbar  to  3d  sacral. 

Gluteal. 

4th  to  5th  lumbar. 

Stroking    the    buttock 
causes    dimpling    in 
fold  of  buttock. 

Inner  side  of  thigh  and 

leg  to  ankle. 
Inner  side  of  foot 

5th  Lumbar. 

Outward  rotators  of  thigh. 
Flexors  of  knae  (Ferrier). 
Flexors  of  ankle.  Peronei. 
Extensors  of  toes. 

Achillis  tendon. 

Ovei'extension      causes 
rapid  flexion  of  ankle, 
called  ankle-clonus. 

Lower    gluteal    region 
back  of  thigh.     Leg 
and  foot,  outer  part. 

1st     and    2d 
Sacral. 

Flexors  of  ankle. 
Long  flexor  of  toes. 
Intrinsic  muscles  of  foot. 

Plantar. 

Tickling   sole    of  foot 
causes  flexion  of  toes 
and  retraction  of  leg. 

Leg    and    foot   except 

inner  side. 
Perineum  and  back  of 

scrotum. 
Anus. 

The  course  of  the  fibres  in  the  spinal  cord,  gentlemen,  is 
only  imperfectly  known.  In  order  to  obtain  a  clear  under- 
standing of  it,  you  must  make  yourselves  perfectly  familiar  with 
the  appearances  presented  by  a  transverse  section  of  the  organ. 

In  such  a  cross-section  you  will  recognize  the  white  sub- 
stance externally  and  the  gray  matter  in  the  form  of  a  letter  H 
in  the  middle.  The  two  lateral  halves  of  the  spinal  cord  are 
divided  by  the  anterior  and  posterior  longitudinal  (median) 
fissures,  and  connected  with  each  other  by  the  anterior  or  white 
commissure  and  the  posterior  or  gray  one.  We  call  the  anterior 
extension  of  gray  matter  the  anterior  horns  (cornua)  and  the 
posterior  extension  the  posterior  horns  or  cornua. 

The  proportions  of  gray  and  white  substance  are  not  the 
same  at  all  levels.     The  gray  substance  predominates  markedly 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC. 


153 


from   the   upper   lumbar   region  down.     Fig.  91    shows  cross- 
sections  made  at  different  levels  in  the  spinal  cord. 

Aside  from  the  proportionate  differences  in  the  gray  and 
white  substances,  you  will  notice  that  the  most  lateral  portion  of 
the  anterior  horns  in  the  lower  cervical  and  upper  dorsal  regions 
become  more  and  more  developed  {D^  and  i)^)  until  they  form 
an  independent  process,  which  is  called  the  lateral  horn  or  inter- 
medio-lateral  tract.  In  the  lower  dorsal  region  the  lateral  horns 
again  disappear.     They  are  shown  at  o  in  Fig.  90. 


Fig.  90. 
Semi-diagrammatic  cross-section  of  spinal  cord,  a,  anterior,  6,  posterior  longitudinal 
fissures  ;  c,  anterior  column  ;  d.  lateral  column  ;  e,  posterior  column  ;  /,  funiculus  gra- 
cilis; 7,  funiculus  cuneatus;  h,  anterior,  i,  posterior  roots;  k,  central  canal;  J,  sulcus 
intemiedius  posticus;  ?;),  anterior  horn;  n,  posterior  horn;  o,  intermedio-lateral  tract ; 
p,  processus  reticularis  ;  q,  anterior  white  commissure  ;  r,  posterior  or  gray  commissure; 
«,  column  of  Clarke,  or  vesicular  colunm.     (After  Erl>.) 

Througliout  the  wliole  cervical  and  the  upper  part  of  the 
dorsal  regions,  in  the  angle  between  the  intermedio-lateral  tract 
and  the  posterior  horn,  the  gray  matter  is  not  sharply  defined, 
but  projects  out  into  the  white  substance  in  the  form  of  a 
net-work  of  gray  bands  and  fasciculi.  This  net-work  is  called  the 
processus  reticularis. 

At  the  terminal  cone  the  gray  matter  is  covered  only  by  a 
thin  layer  of  white  substance  (6'o,  Fig.  91). 


154 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


The  root-fibres  of  the  motor  nerves  pass  by  the  spinal 
ganglia  directly  into  the  spinal  cord,  traverse  the  white  substance, 
and  enter  the  anterior  horn.  It  is  very  probable  that  the  axis- 
cylinders  of  all  these  fibres  are  connected  with  the  large  ganglion- 


FiG.  91. 

Sections  through  the  spinal  cord  at  different  heights.    The  letters  and  figures  show  the 
spinal  nerves  at  the  level  of  whose  exit  the  section  is  made.    (After  Quain.) 


cells  as  shown  in  Fig.  92.  These  cells,  which  constitute  the 
first  station  of  the  motor  innervation-tract,  are  so  distributed 
over  the  section  of  the  spinal  cord  that  we  can  make  out  (to  the 
left  at  m  in  Fig.  90)  more  or  less  distinctly  a  median  and  a 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC. 


155 


lateral  group  in  front,  and,  behind  the  latter,  a  central  group. 
In  the  cervical  cord  there  is  also  a  group  in  the  lateral  horn. 

On  making  a  longitudinal  section  we  see  that  these  cells 
are  somewhat  more  plentiful  opposite  the  entrance  of  each  root ; 
that  is  to  say,  they  are  arranged  in  segments.  We  call  such  an 
aggregation  of  cells,  together  with  the  root  arising  from  it,  a 


Fig.  92. 

From  the  anterior  border  of  a  section  through  thi-  anterior  horn  of  the  gray  matter. 
Passage  of  the  cell  processes  into  nerve-roots.    Carmine  stain  *p.     (After  Itenle.) 

segment  of  the  spinal  cord.  In  human  beings  the  segmentation 
of  the  cord  is  almost  obliterated,  but  it  is  more  pronounced  in 
the  lower  animals. 

Nothing  is  certainly  known  as  to  the  course  of  those  pro- 
cesses of  the  ganglion-cells  which  do  not  terminate  in  axis- 
cylinders:  a  few  app(?ar  to  extend  directly  to  other  ganglion- 
cells;  the  majority,  however,  are  lost  in  a  fine  n(;t-work  of  most 


156 


LECTURES   ON   THE   CENTRAL   NERVOUS   SYSTEM. 


delicate  fibrils,  which  permeates  all  the  gray  matter,  and  of 
which  it  is  still  doubtful  whether  or  not  it  is  nervous  tissue. 

The  sensory  roots,  after  passing  through  the  spinal  ganglia, 


— -  Cp 


Cc 


Caa 


Ra 
Fig.  93. 

■'      ■      Half  of  a  section  through  the  lumbar  cord.    Äa,  anterior  I'oot ;  iZp,  posterior  root ;    ■ 
Rip,  inner  portion  of  the  posterior  root ;  Cp,  posterior  commissure ;  Caa,  anterior  com- 

:  missure  :  Ce,  central  canal.  The  fine  net-work  of  medullary  fibres  in  the  gray  matter  and 
the  net-work  of  medullary  fasciculi  in  the  otherwise  gray  posterior  commissure  are  not 
shown.    (After  Deiters.) 

run  in  part  direct  to  the  posterior  horn  and  in  part  to  the 
posterior  white  columns.  The  cell-complex  of  the  spinal  gan- 
glion is  the  real  source  from  whieh  these  fibres  arise.  You 
recollect  that  embryology  shows  that  the  cells  of  this  ganglion 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC. 


157 


grow    peripherally    toward    the    nerves    and    centrally    in    the 
direction  of  the  spinal  cord. 

The  centripetal  processes  form  what  we  call  the  posterior 
root.  It  is,  however,  joined  by  fibres  which  do  not  originate  in 
the  cells  of  the  spinal  ganglia.  These  are  apparently  the  fibres 
which  we  see  passing  to  a  peculiar  group  of  cells  which  resemble 


Fig.  »4. 


Cross-section  of  the  vesicular  column  (v).     Fp,  funiculus  post. 
(After  Henle.) 

those  of  the  spinal  ganglia.  This  group,  columna  vesicularis, 
or  column  of  Clarke  (Fig.  90),  lies  about  at  the  junction  of  the 
anterior  and  posterior  horns.  Besides  these  cells  it  contains  a 
small  bundle  of  extremely  fine  nerve-fibres,  which  run  in  tlie 
long  axis  of  the  spinal  cord. 

The  vesicidar  column  can  only  be  distinctly  traced  from 
about  the  end  of  the  cervical  to  the  beginning  of  the  lumbar 


158  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

enlargement;  it  probably,  however,  extends  high  up  into  the 
medulla  oblongata. 

At  the  tip  of  the  posterior  horn  there  is  found  a  glassy, 
semi-transparent  body, — the  substantia  gelatinosa  E-olandi.  As 
has  been  shown  by  Corning,  this  is  the  remains  of  a  tissue  which 
was  present  throughout  the  spinal  cord  during'  the  embryonal 
period.  Its  cells  strongly  resemble  ganglion-cells,  but  their 
nature  is  still  unknown.  Many  fibres  of  the  posterior  root  pass 
through  it  (Fig.  93). 

At  several  points  in  the  gray  matter  there  can  be  seen  but 
few  nerve-fibres,  and  scarcely  any  ganglion-cells.  At  these 
points  the  neuroglia  is  the  only  constituent,  and  they  therefore 

present  a  pale-grayish,  translucent 
appearance  to  the  naked  eye.  A 
very  plentiful  deposit  of  neuroglia 
is  situated  around  the  central  canal, 
and  is  called  the  substantia  gelati- 
nosa centralis.  The  whole  periph- 
ery of  the  spinal  cord  is  also  cov- 
ered with  a  thin  mantle  of  almost 

Fig.  95.  t  i  i      • 

Part  of  cross-section  of  the  white     puro  ncuroglia, — the  gelatmous  cor- 

Substance  of  one  of  the  lateral  columns.  •       t   i 

The  transversely-divifled  nerve-fibres,       tical  laver. 

in  the  centre  of  each  of  which  is  an      ;,  •'       ' 

roglia  containing  Deiters' ceUs.  (After  ihowhlte  SUbstaUCe  SUrrOUUd- 

ing  the  gray  matter  consists  prin- 
cipally of  fibres  running  lengthwise  of  the  spinal  cord,  of  the 
obliquely-ascending  roots  of  the  nerves,  and  of  fibres  which 
run  more  or  less  perpendicular  to  the  long  axis  of  the  cord, 
from  the  gray  matter  into  the  white  substance.  The  nerve-fibres 
have  an  axis-cylinder  and  a  medullary  sheath.  The  width  of 
the  latter  varies  greatly.  The  sheath  of  Schwann  is  wanting. 
Between  the  fibres  lies  the  neuroglia,  which  at  many  points  is 
continuous  with  a  fibrous  connective  tissue.  In  this  connective 
tissue,  which  is  continuous  externally  vi^ith  the  neuroglia  and 
with  the  pia  mater,  are  situated  blood-vessels  which  have  a  some- 
what radial  arrangement.     The  neuroglia  consists  here,  as  in  the 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC. 


159 


gray  matter,  of  numerous  cells  with  long,  slender  processes.  The 
body  of  the  cell  is  usually  so  small  that  the  processes  have  the 
appearance  of  springing  from  the  nucleus.  Occasionally,  how- 
ever, it  is  larger.  These  cells  are  called  the  spider-cells,  or  cells 
of  Deiters.     (See  Fig.  95,  at  left). 

The  spinal  cord  is,  as  a  glance  at  a  transverse  section  will 
show,  divided  into  several 
columns  by  the  entering  nerve- 
roots  and  the  longitudinal  fis- 
sures. Internal  to  the  spinal 
nerve-roots  are  situated  the 
anterior  or  posterior  columns, 
as  the  case  may  be,  and  exter- 
nal to  them  the  lateral  columns. 

The  study  of  embryology 
and  the  investigation  of  cer- 
tain diseases  of  the  spinal  cord 
show  that  the  anterior,  lateral, 
and  posterior  columns  are  not 
uniform  masses  of  fibres  of 
equal  importance,  as  might 
appear  from  a  section  through 
the  adult  organ,  but  that  they 
are  composed  of  several  dif- 
ferent divisions. 

You  remember  the  pyra- 
midal tract,  whose  course  we 
traced  fro.m  the  cortex  of  the 
motor  zone  through  the  capsule  and  the  crusta  to  the  ventral 
])art  of  the  pons. 

Let  us  ascertain  in  what  part  of  the  spinal  cord  this  tract 
is  situated.  It  is  not  diffif;ult  to  discover  this.  If  a  destructive 
disease  involves  any  part  of  this  extensive  tract  the  nerve-fibres 
disappear,  and  are  replaced  by  connective  tissue.  This  process, 
which  is  called  secondary  degeneration,  continues  downward 


Fig.  90. 

Diagram  of  descendiiig  degeneration  in  the 
pyramid,  with  a  lesion  in  the  left  internal 
capsule. 


160  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

into  the  spinal  cord.  Here  it  occupies  two  regions, — ^first,  the 
innermost  portion  of  the  anterior  column  on 
the  side  of  the  brain-lesion,  and,  secondly,  a 
large  area  in  the  lateral  column  of  the  oppo- 
site side.  High  up,  at  the  commencement 
of  the  oblongata,  we  see  that  the  crossed  de- 
generation passes  back  to  the  side  of  the  un- 
crossed degeneration ;  that  is,  the  degenerated 
tract  decussates  with  the  normal  pyramidal 
tract.  The  tract  which,  in  this  instance,  is 
involved  in  the  descending  degeneration  is 
called,  as  in  the  brain,  the  pyramidal  tract. 
In  the  spinal  cord  it  is  divided  into  the 
anterior  (columnar)  pyramidal  tract  (most 
median  part  of  anterior  column)  and  the 
lateral  (columnar)  pyramidal  tract  (in  the 
posterior  portion  of  the  lateral  column). 
There  are  grounds  for  believing  that  these 
pyramidal  tracts  contain  most  of  those  fibres 
from  the  brain  to  the  spinal  cord  which  con- 
vey the  impulses  for  conscious  movement. 
They  degenerate  only  downward ;  their  nerve- 
fibres  always  disappear  if  the  cross-section  of 
the  tract  is  destroyed  at  any  point  of  its  course 
in  the  brain  or  spinal  cord.  In  human  beings 
all  the  tracts  in  the^  spinal  cord  have  their 
medullary  sheaths  at  the  time  of  birth.  The 
pyramidal  tract  is  the  only  exception  to  this 
rule.  On  a  section  taken  from  the  spinal 
cord  of  a  newborn  child,  therefore,  the  pyra- 
midal tracts  appear  gray  in  the  midst  of  the 

Secondary  descending    whitC  lateral  ColumUS. 
degeneration  following  a  .  «    ,i  •  ^    ^    j 

lesion  in  the  left  cerebral  1  he  cross-scctiou  01  tlic  pyramidal  tract 

hemisphere.  (After  Erb.)  '-  •' 

diminishes    gradually    toward     the    lumbar- 
region.     In  the  lower  dorsal  region  the  pyramidal  tract  of  the 


THE  ROOTS  OF  THE  PEKIPHEHAL  NKHVES.  ETC. 


161 


anterior  column  can  no  lono^er  be  seen,  because  its  fibres  are  lost 
in  tlie  regions  from  which  the  motor  nerves  issu(\  In  Fig.  100 
the  points  7  and  7'  give  a  general  idea  of  tlie  pyramidal  tract  at 
different  levels  of  the  spinal  cord. 

Tli(^  examination  of  spinal  cords  affected  by  secondary 
degeneration  throws  still  more  light  upon  their  structure.  If 
Ave  make  sections  of  spinal  cord  whose  continuity  has  been  in- 
terrupted in  the  dorsal  portion  by  pressure  or  any  other  violence, 
we  shall  find,  as  might  be  expected  from  what  has  already  been 


Fig.  98. 
Cross-sfction  tlirouffh  the  cprvical  cord  of  a  newborn  child.    The  pjTamidal  tracts 
without  medullary  filties  aiijx'ar  iilisteuing  and  clear.    The  direct  i>yrauiidal  tract  in  the 
anterior  column  cncroaclics  uiarkedly  upon  theanti-ro-lateral  cr>lumii. 

Grenzftrhii-ht,  Limitinj^  layer. 
Griintlhiintlfl.  Ur»iitiil-liiiii(Ile. 
Kleinltirniit:iOn.itriiii;i-hiilin.  I-utcral  cereVjellar  tract. 


Sfilennfranii,  Lateral  column. 
Vnrrlirnlrinifi,  Anterior  column. 
Witrzfl  Ziiiir,  Zone  of  the  roots. 


said,  that  the  pyramidal  tracts  on  each  side  have  become  degen- 
erated downward.  But  there  is  also  a  degeneration  upward  from 
the  level  of  the  injury.  At  first  this  degeneration  occupies  the 
whole  area  of  the  posterior  c;olumn,  but  at  a  point  a  lew  seg- 
ments higher  up  it  is  limited  to  that  part  of  the  column  which 
lies  along  the  posterior  median  fissure.  In  such  specimens  we 
can  easily  divide  the  posterior  column  into  an  inner  and  an 
outer  one.  The  parts  affected  by  this  ascending  degeneration 
(which  extends  into  the  oblongata)  are  fibres  of  the  posterior 


162 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


roots,  which  have  been  divided  from  their  gangiion-cells  in  the 
spinal  ganglia.  If  we  divide  these  posterior  roots  experiment- 
ally jnst  outside  the  spinal  column  (Singer)  we  shall  produce  an 
exactly  similar  degeneration.  Just  abo\  e  the  divided  point  both 
the  outer  and  tlie  inner  posterior  columns  are  degenerated; 
farther  up  new  and  liealthy  root-fibres  enter  and  arrange  them- 
selves to  the  outside  of  the  injured  ones,  so  that  the  area  of 
degeneration  is  gradually  puslied  farther  and  farther  toward  the 
median  line  as  we  pass  higher  up  in  the  cord. 
The  study  of  the  development  of  the 
medullary  sheaths  confirms  the  conclusion 
reached  by  the  investigation  of  secondary 
degeneration.  It  teaches  tliat  there  are  here, 
at  least,  two  sets  of  fibres, — an  outer  one, 
ordinarily  called  the  fmidamental  bundle  of 
the  posterior  column,  also  called  wedge-shaped 
column,  or  column  of  Burdach,  and  an  inner 
one,  which  is  called  the  slender  column 
(funiculus  gracilis),  or  Goll's  tract.  In  the 
normal  adult  cord  the  two  divisions  of  the 
posterior  column*  are  separated  from  each 
other  by  a  septum  of  connective-tissue  only 
in  the  cervical  region.  In  sections  made 
lower  down  we  can  only  distinguish  them 
when  one  or  the  other  is  degenerated,  and 
therefore  is  differently  stained.  Goll's  tract 
increases  in  size  from  below  upward  as  far  as 
the  upper  dorsal  region,  probably  because  portions  of  the  pos- 
terior nerve-roots  are  continually  entering  it  on  their  way  to  the 
medulla  oblongata.  It  is  not  improbable  that  still  furtlier  sub- 
divisions of  the  posterior  columns  will  be  made  in  the  future. 
The  manner  of  extension  of  certain  diseases,  and  occasional  rare 
forms  of  secondary  degeneration,  lead  us  to  anticipate  tliis. 


Fig.  m. 
Ri^condary  ascending 
and  descending  degenera- 
tion followiiig  a"  trans- 
verse division  of  tlie  eord 
in  tlie  upper  dorsal  re- 
gion.   (After  Strümpell.) 


*  Funiculus  cuneatus  and  funiculus  gracilis  in  Fi 
postero-internal  columiis. 


B,  also  called  pnstero-external  and 


THK    HOOTS    OF    THE    PEKJl'HEKAL    NERVES,    ETC. 


1()3 


The  region  near  tlie  gray  coinmissun',  wliich  is  mark(Ml  A  in 
Fig.  98,  on  the  left,  must  contain  a  distinct  system  of  fibres, 
because,  for  example,  it  never  becomes  involved  in  cases  of 
tabes,  even  tliougli  tlie  other  parts  of  the  posterior  columns 
degenerate.  We  may  call  this  the  ventral  field  of  the  posterior 
column. 

The  posterior  columns  consist  of  the  entering  fibres  of  the 
1 


Ficf.  IW. 

Section«  tlinnigh  tlie  spinal  cord  in  the  upper  cfrvical  region,  the  dorsal  region,  and 
the  middle  of  the  lumbar  region.  Boundaries  of  the  ditf'erent  cfdumns  of  tlie  white 
sabstance.  1.  Basal  hiiiiille  of  the  anterior  column.  2.  Basal  bundle  of  posterior  cf)luinn, 
the  wedge-shajied  coluiim  or  column  of  IJurdacti.  ?,.  Anterior  mixed  zone  of  lateral 
column.  1.  Ijateral  boundary -layer  of  gr:iy  substance.  .5.  The  delicate  column,  or  column 
of  fjoll.  ft.  r^ateral  cerebellar  tract.  7.  Oossed  pyramidal- tract  in  lateral  column. 
7'.  Direct  i)yiamidal  tract  in  anterior  column.  «,  anterior  roots.  The  gray  substance  is 
shown  black.    (After  Flechsig.) 


posterior  roots.  Tlieso  roots  are  arranged  in  such  a  way  tliat 
when  they  first  enter  tlie  cord  they  lie  on  the  outer  side  near  the 
posterior  lioni,  ;iiid  those  entering  Jifterwnrd  (ij-.,  aljove  tlietn) 
crowd  th(;ir  predecessors  inward.  Thus  it  ]Ki[)pens  tliat  in  the 
cervical  region  tlie  fibres  from  the  lower  extremities  are  found 
principally  in  the  colmnii  of  (ioll,  while  the  colii^n  of  IJurdMcli 
contains  very  many  fibres  from  the  u})[)er  (.'xtremities.  You 
must  not  imngine,  gentlemen,  that  these  divisions  of  the  posterior 


164  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

columns  convey  upward  all  the  fibres  of  any  posterior  root. 
Many  of  the  fibres  pass  into  the  gray  matter  directly  after  the 
root  has  entered  the  spinal  cord,  and  others  pass,  first  into  the 
posterior  horn  and  then  into  the  gray  matter.  Therefore,  rela- 
tively few  of  those  fibres  which  entered  the  posterior  columns 
below  are  to  be  found  in  the  upper  part  of  the, cord.  Experi- 
mentally we  have  ascertained  that  the  area  of  degeneration  due 
to  section  of  a  posterior  root  becomes  continually  smaller  as  it 
is  traced  upward.     At  the  same  time  it  moves  inward. 

At  the  upper  part  of  the  spinal  cord  the  funiculus  cuneatus 
receives  fibres  which  do  not  come  directly  from  the  posterior 
roots.     Their  origin  is  uncertain. 

But,  as  you  have  been  told  before,  all  the  sensory  fibres  do 
not  terminate  in  the  cells  of  tlie  spinal  ganglia ;  a  part  pass 
through  the  ganglia  apparently  to  end  in  the  cells  of  the  column 
of  Clarke,  their  first  terminal  station.  These  fibres  remain 
normal  when  the  root  is  cut  across,  for  the  reason  that  they  are 
not  divided  from  their  own  cells  in  that  experiment.  They  do 
degenerate,  however,  if  the  continuity  of  the  spinal  cord  itself 
is  broken.  In  fact,  in  the  latter  case  (Fig.  99),  we  see  still 
another  tract  of  fibres  degenerate.  It  is  that  shown  in  tlie 
peripheral  portion  of  the  lateral  columns  at  6,  in  Fig.  100. 
This  tract  can  be  traced  as  far  as  the  worm  of  the  cerebellum. 
It  is  owing  to  embryological  researches  (Flechsig)  that  we  are 
able  to  recognize  and  distinguish  this  direct  lateral  cerebellar 
tract  from  other  tracts  in  the  lateral  column.  In  the  first  weeks 
of  life,  before  the  pyramidal  tract  has  become  medullated,  the 
cerebellar  tract  lies  like  a  delicate  white  border  along  one-half 
of  the  periphery  of  the  lateral  column. 

Just  in  front  of  the  cerebellar  tract  lies  a  tract  which  projects  like  a  wedge 
from  the  periphery  of  the  lateral  column  toward  the  centre.  It  is  not  indicated 
in  the  diagrams,  but  is  apparently  independent,  for  it  may  degenerate  (upward) 
by  itself     It  is  called  the  fasciculus  antero-lateralis. 

By  the  study  of  secondary  degeneration  and  embryology, 
therefore,  we  have  discovered  the  following  systems  of  white 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC.       165 

fibres.  To  these  .sul)cli\  isious  we  have  given  the  general  name 
of  cohimnar  systems.  In  the  anterior  columns  the  anterior 
direct  pyramidal  tract ;  in  the  lateral  columns  the  lateral  crossed 
pyramidal  tract,  and  the  direct  cerebellar  tract ;  in  the  posterior 
columns  the  ground-biuidles  and  the  funiculi  graciles. 

If  you  will  look  at  Fig.  100  you  will  observe,  aside  from 
the  above-named,  two  areas  in  the  section  which  have  been  left 
white.  They  are  marked  1  and  3,  and  are  situated  in  the 
anterior  and  lateral  columns.  They  are  probably  a  region  \vhich 
is  only  traversed  by  the  anterior  roots,  and  have  received  the 
name  of  remnant  of  the  antero-lateral  column.  The  part  lying 
in  the  anterior  column  is  also  called  the  anterior  ground-bundle 
(1,  in  figure).  The  part  lying  in  the  lateral  column  has  received 
the  name  of  anterior  mixed  zone  of  the  lateral  column  (3,  in 
the  figure).  The  fibres  of  the  remnant  of  the  antero-lateral 
column  arise  in  part  in  the  anterior  roots  and  in  part  in  the 
gray  matter.  They  come  principally  from  the  centripetal  pro- 
cesses of  the  sensory  tract.  The  field  marked  4  in  Fig.  100 
(lateral  limiting  layer  of  the  gray  matter)  contains  the  direct 
continuations  of  the  nerve-roots  which,  after  passing  transversely 
through  tlie  posterior  horn  (see  Fig.  98),  ascend  in  this  layer. 

L(3t  us,  now  that  we  have  learned  the  general  arrangement 
of  the  structures  of  tlie  spinal  cord,  see  what  becomes  of  the 
entering  root-fibres,  tlie  examination  of  which  we  abandoned 
for  a  time.  Let  us  see  how  far  their  course  within  the  central 
organ  has  been  investigated.  We  are  no  longer  considering  the 
form  and  arrangement  of  the  different  parts  of  the  central 
nervous  system  ;  that  which  now  demands  our  attention  is  the 
intimate  connection  between  its  constituent  elements,  the  relation 
of  fil)re  to  fibre  and  of  fibre  to  cell. 

The  fasciculi  of  the  antcnior  roots  pass  in  a  gentle  ascent 
through  the  midst  (jf  the  antero-lateral  columns.  Each  fasciculus 
is  spread  out  over  a  large  extent  of  the  white  substance.  For 
tins  reason  any  injury  to  the  column  must  involve  a  certain 
number  r)f  the  anterior  root-fibres,  and  it  is  therefore  impossible 


166 


LECTURES   ON   THE    CENTRAL   NERVOUS    SYSTEM. 


to  arrive  at  any  conclusion  concerning  the  function  of  the  antero- 
lateral column  proper  by  section  experiments  on  animals.  The 
anterior  roots,  which  contain  motor  fibres,  and  also  exert  a 
trophic  influence  on  both  muscle  and  nerve,  are  an  important 
constituent  of  the  columns  now  under  consideration. 

The  accompanying  drawing  and  Fig.  102  will  give  you  an 
idea  of  the  central  course  of  the  anterior  roots. 

On  reaching  the  gray  substance  the  component  fibres  of 
each  bundle  separate.  There  are  many  and  conflicting  state- 
ments as  to  the  ultimate  destiny  of  these  fibres. 
The  following  explanation,  which  is  based 
largely  on  my  own  investigations,  is  an  at- 
tempt to  harmonize  the  most  important  of 
these  statements. 

First,  we  may  consider  it  as  settled  that 
the  fibres  of  the  anterior   roots   pass  to  the 
^:^\y^li  ganglion-cells  of  the  anterior  horn,  or,  rather, 

^^^^^^•'^  become   continuous  with    their   axis-cylinder 

process  (see  Fig.  92).  A  few  of  these  fibres 
pass  to  the  cells  of  the  opposite  anterior  horn 
by  way  of  the  anterior  commissure. 

The  nuclei  of  the  anterior  roots  are  con- 
nected by  nerve-fibres  with  the  pyramidal 
tracts.  We  see  large  numbers  of  these  fibres 
at  the  bottom  of  the  anterior  median  fissure 
passing  across  the  middle  line  of  the  anterior  direct  pyramidal 
tract.  The  fibres,  from  the  anterior  horn  to  the  lateral  crossed 
pyramidal  tract,  are  less  easily  demonstrated  on  account  of  the 
obliquity  of  their  course  and  the  extreme  difliculty  of  making  a 
section  exactly  in  their  plane.  In  Fig.  102  these  central  portions 
of  the  motor  tract  are  indicated  by  fine  lines,  the  peripheral  (gan- 
glion-cells of  the  roots)  with  coarse  ones.  The  nature  of  union 
between  the  ganglion-cells  and  the  pyramidal  fibres  is  unknown. 
Fibres  pass  from  the  anterior  horn  to  the  lateral  and  median 
portions  of  the  ground-bundle  of  the  antero-lateral  column. 


Fig.  101. 
Passage  of  the  ante- 
rior  roots    through    the 
substance  of  the  spinal 
cord.     (Diagrammatic.) 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC.       167 

The  anterior  commissure  is  composed  of  the  central  fibres 
from  the  root-nuclei  to  the  opposite  anterior  pjTamidal  tract,  the 
fibres  from  the  roots  to  the  corresponding  cells  of  the  opposite 
side,  and  of  fibres  from  the  posterior  horn. 

All  these  fibres  are  surrounded  and  enclosed  by  an  extra- 
ordinarily close  tangle  of  fibres,  the  unraveling  of  wliich  has 
never  been  accomplished.  This  mass  of  fibres,  without  doubt, 
contains  other  nerve-tracts  of  which  we  know  nothing.  Tliat 
portion  of  this  net-work,  which  is  medullary  at  birth,  is  correctly 
depicted  in  Fig.  98. 

The  investigation  of  the  relations  of  the  posterior  roots 
presents  peculiar  difficulties.  We  never  see  a  fibre  connect 
unmistakably  with  a  cell-process :  there  is  always  a  net- 
work between  the  two.  We  must  bear  in  mind,  too,  that  the 
greater  part  of  these  roots  is  made  up  of  central  fibres ;  that  is, 
of  fibres  which  liave  already  passed  their  first  terminal  station 
(the  spinal  ganglion).  AVe  have  made  out  tlie  course  of  some 
of  tliese  central  fibres  by  the  study  of  secondary  degeneration. 
We  have  seen  that  they  pass  directly  into  the  column  of  Bur- 
dach  along  with  the  root-fibres,  and  that  they  show  a  tendency 
to  pass  more  and  more  to  the  median  line,  so  that  in  levels 
above  tlieir  point  of  entrance  they  lie  nearer  the  middle  line  in 
the  cohimn  of  Goll.  But  we  have  also  seen  that,  while  tliey 
were  working  toward  tlie  median  line,  they  were  continually 
giving  off  fibres  to  the  gray  matter. 

If  I  am  to  succeed  in  giving  you  a  clear  explanation  of  the 
complicated  relations  existing  at  the  entrance  of  the  posterior 
roots,  I  must  particularly  request  you  to  study  the  following 
text  with  continuous  reference  to  Fig.  102. 

On  a  trans\(;rse  section  of  tlie  spinal  cord  we  see  that  the 
posterior  root  divides  into  at  least  four  parts.  The  most  median 
bundle  (1,  in  Fig.  102),  which  consists  of  coarse  fibres,  passes 
almost  entirely  and  directly  into  the  white  posterior  columns  at 
the  same  l(!vel  with  thtjir  point  of  entrance.  These  are  the 
before-mentioned  central  tracts  ;  along  with  these,  fibres  of  equal 


168 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


size  (2,  Fig.  102)  pass  into  the  spinal  cord,  which  do  not  run 
directly  toward  the  median  line,  but  pass  in  a  curve  through  the 
white  substance  laterally  toward  the  columns  of  Clarke,  where 
they  are  lost  sight  of.  A  few  fibres  run  directly  through  the 
posterior  horn  \entrad  of  the  substantia  gelatinosa,  and  then 


Fig.  102. 

Diagram  of  a  transverse  section  of  the  spinal  cord,  showing  the  central  course  of  some 

of  the  most  important  tracts.    Compare  Fig.  98,  which  is  not  diagrammatic. 

Grenzschicht.  Limiting  layer.  Grund  Bündel,  Ground  bundle. 

Kleinhirn-Seitenstrunff-Bahn,  Lateral  cerebellar  tract.  Pyramid.  Vnrd-St.  B.,  Anterior  pyramidal  tract. 

Pyramiden-Seitenatr.  B.,  Lateral  pyramidal  tract.  Seitenstr.,  Lateral  column. 

Vorderstr.,  Anterior  column. 


continue  their  course  into  the  limiting  layer  of  the  lateral 
column.  They  are  shown  with  peculiar  distinctness  in  Fig.  98. 
The  two  last-described  portions  of  the  posterior  roots  lie  on 
the  median  side  of  the  apex  of  the  posterior  horn.  Laterally 
from  these  lie  the  bundles  which  are  distributed  to  the  latter ; 
we  can  distinguish  both  coarse  and  fine  fibres.  Neither  of  them 
terminate  at  the  level  of  their  entrance  into  the  cord.    The  larger 


THE  ROOTS  OF  THE  PERIPHERAL  NERVES,  ETC.       169 

fibres  (o,  in  Fig.  102)  pass  directly  through  the  substantia  gela- 
thiosa  Rohmdi,  which  Hes  at  the  tip  of  the  posterior  horn,  and 
at  once  turn  upward  and  downward,  and  only  pass  farther  into 
the  gray  substance  at  other  levels.  The  fine  fibres  (4,  in  Fig. 
102)  become  separated  from  the  coarse  immediately  after  the 
entrance  of  the  root,  and  pass  as  a  separate  bundle  upward  and 
downward  between  the  tip  of  the  substantia  gelatinosa  and  the 
periphery.  The  cross-section  of  this  fasciculus  was  called  zona 
terminalis  by  Lissauer,  to  whom  we  are  mainly  indebted  for  our 
knowledge  on  this  point.  Fibrils  are  continually  given  off"  from 
the  zona  terminalis  to  a  net-work  lying  between  it  and  the  sub- 
stantia gelatinosa.  This  net-work  is  called  the  zona  spongiosa, 
and  from  it  fine  fasciculi  arise,  which  pass  into  the  substantia 
gelatinosa  and  are  lost  in  the  maze  of  fibres  which  make  up  the 
main  mass  of  the  posterior  honi.  From  this  intricate  maze  of 
fibres  are  developed  new  fasciculi,  which  pass  across  to  the 
opposite  side  through  the  anterior  and  posterior  commissures, 
and,  emerging  from  the  gray  matter,  are  continued  upward  to  the 
1)rnin  in  the  ground-bundles  of  the  anterior  and  lateral  columns. 

We  have,  therefore,  distinguished  two  paths  in  which 
the  fibres  of  the  posterior  roots  are  continued  upward, — a 
direct  one,  in  the  posterior  columns,  and  an  indirect  path  by 
which,  after  passing  through  the  posterior  horn,  in  some  un- 
kn.own  manner,  the  fibres  cross  to  the  opposite  side.  We 
shall  see  later  that  the  direct  fibres,  alter  passing  through  a 
nucleus  in  the  medulla  oblongata,  also  decussate. 

It  would  not  have  been  possible  for  me  to  recognize  this 
arrangement  of  tlie  fibres  of  the  posterior  root  were  it  not  for 
the  fact  that,  in  tlie  lower  vertebrates,  the  order  of  the;  fibres  in 
the  spinal  cord  is  a  very  simple  one:  I  might  almost  call  it 
<Uagranimatic.  On^je  it  was  shown,  in  the  case  of  tliese  animals, 
that  the  majority  of  tlie  posterior  roots  pass  througli  a  net-work 
and  ailerward  decussate  before  continuing  on  tlieir  course  to 
tlie  i)rain,  it  was  easy  to  recognize  the  same*  conditions  in  liuman 
beinirs  and  other  mammals. 


170  LECTURES   ON    THE    CENTRAL   NERVOUS    SYSTEM. 

Knowledge  obtained  by  experiment  and  at  the  bedside  confirms  these  late 
discoveries.  If  one-half  of  a  spinal  cord  is  divided  the  sensation  of  the  skin  is 
lost  below  the  point  of  division,  and  that  not  on  the  same  but  on  the  opposite 
side.  We  had  previously  been  at  a  loss  to  harmonize  this  fact  with  our  knowl- 
edge that  posterior  root-fibres  were  continued  directly  (without  decussation)  in 
the  posterior  columns.  The  phenomenon,  however,  was  at  once  explained  when 
we  discovered  that  a  considerable  portion  of  each  root  passed,  in  some  way  not 
clearly  understood,  to  the  opposite  side  shortly  after  entering  the  cord. 

You  will  at  once  be  struck  by  the  remarkable  analogy  ex- 
isting between  the  central  fibres  of  the  anterior  and  posterior 
roots.  In  the  former  we  have  (in  relation  to  the  root)  a  direct 
tract  (the  lateral  pyramidal  tract)  and  a  crossed  tract  (the 
anterior  pyramidal  tract). 

The  principal  distinction  between  the  motor  and  sensory 
tracts  consists  in  the  different  mechanisms  which  are  interposed 
between  the  cells  from  which  they  originate  and  the  point  of 
their  decussation. 

While  there  is  good  cause  to  believe  that  this  mechanism  is 
very  simple  in  the  anterior  horn,  apparently  residing  in  the  cell 
itself,  we  see,  in  the  case  of  the  posterior  roots,  a  whole  net-work, 
itself  filled  with  small  cells,  thrust  in  between  the  cells  of  the 
spinal  ganglia  and  the  decussation. 

We  shall  have  occasion  again  to  refer  to  this  important 
matter  when  we  study  the  oblongata. 

We  must  now  consider  that  portion  of  the  posterior  root 
which  does  not  arise  from  the  cells  of  the  spinal  ganglion  but  is 
connected  with  the  columns  of  Clarke.  Pathological  observa- 
tions go  to  show  that  this  portion  has  probably  nothing  to  do 
with  conveying  sensory  impressions  from  the  skin.  The  central 
connecting  fibres  from  the  columns  of  Clarke  do  not  pass 
upward  in  the  general  sensory  tract.  They  send  off  fibres  which 
pass  out  laterally  from  the  gray  matter,  and  reach  the  direct 
lateral  cerebellar  tracts  in  the  periphery  of  the  white  substance, 
and  in  these  tracts  they  pass  to  the  cerebellum.  These  fibres 
are  apparently  of  importance  in  the  co-ordination  of  movements. 
We   not   only   see   disturbances   in    co-ordination  of  gait  and 


THE    ROOTS    OF    THE    PERIPHERAL    NERVES,    ETC.  171 

posture  ill  cerebellar  disease,  but  in  tabes  dorsalis,  where  the 
highest  degrees  of  ataxy  are  sometimes  present,  the  fibres  of  the 
posterior  and  of  the  vesicular  columns  are  degenerated:  the 
continuity  of  the  tracts  to  the  cerebellum  is  broken. 

The  anatomy  of  the  spinal  cord,  so  far  as  it  could  be  ascertained  microscopi- 
cally, was  described  by  Burdach,  Sömmering,  and  F.  Arnold.  Bellingeri  first 
discovered  the  connection  existing  between  the  anterior  roots  and  the  gray  matter 
of  the  anterior  horns,  while  Grainger  rendered  the  same  service  with  respect  to 
the  posterior  roots  and  the  posterior  horns.  The  finer  structure  of  the  spinal  cord, 
however,  was  first  discovered  by  B.  Stilling,  and  after  him  additional  light  was 
thrown  on  the  matter  by  Kölliker,  Goll,  Deiters,  Gerlach,  Clarke,  and  others. 
We  owe  our  knowledge  of  the  course  of  fibres  in  the  white  substance  principally 
to  the  works  of  Turk,  Flechsig,  Charcot,  and  Gowers. 

The  picture  which  I  have  given  you  to-day  of  the  most  im- 
portant tracts  of  fibres  in  the  spinal  cord  might  be  made  much 
more  complete,  might  be  improved  by  many  highly  interesting 
details.  We  have  touched,  however,  upon  many  points  where 
our  knowledge  is  uncertain,  so  tha!  a  faithful  adherence  to  the 
object  of  these  lectures  will  compel  us  to  stop  at  this  place, 
where  the  lack  of  known  details  and  the  conflicting  opinions  of 
authors  prevent  us  from  laying  before  the  student  clear  and 
definite  views. 

In  the  preface  to  his  great  work  on  the  structure  of  the 
spinal  cord.  Stilling  says,  "  We  must  not,  to  borrow  the  lan- 
guage of  the  distinguished  Burdach,  forget  that  in  investigating 
the  spinal  cord  we  are  traveling  through  a  wonderland  of  wliich 
we  have  no  accurate  knowledge.  We  can  only  turn  our  atten- 
tion to  the  rivers  and  mountains  in  order  to  get  a  general  idea 
of  the  wliole,  and  must  leave  it  to  those  who  follow  to  trace  up 
and  map  out  the  minor  features  of  the  landscape."  Thirty  years 
have  passed  away  since  this  preface  was  sent  forth  into  the  world 
with  a  book  richer  in  material  than  any  ever  before  presented  to 
anatomical  science.  We  are  still  far  from  the  goal,  and  it  will 
be  long  before  that  perfect  map  can  be  drawn  of  which  both 
Stilling  and  Burdach  dreamed. 


LECTURE  X. 

THE    SPINAL   CORD    AND    THE    COMMENCEMENT    OF    THE    MEDULLA 

OBLONGATA. 

Gentlemen:  In  the  spinal  cord,  fibres  of  widely  different 
physiological  significance  lie  crowded  closely  together.  Those 
cells  which  we  regard  as  central  organs  lie  side  by  side  witli 
peripheral  structures.  You  will,  therefore,  easily  understand 
how  extremely  difficult  it  is  to  detect  the  consequences  and 
symptoms  which  follow  a  disease  or  injury  of  any  one  of  these 
components  of  the  spinal  cord. 

Nevertheless,  careful  observation,  both  at  the  bedside  and 
at  the  post-mortem  table,  has  taught  us  much  in  this  connec- 
tion. A  certain  number  of  diseases  aft'ect  only  certain  regions 
of  the  spinal  cord,  always  confining  themselves  to  particular 
columns  or  groups  of  cells,  and  leave  all  other  parts  of  the  cord 
intact,  or  at  least  invade  them  very  slowly.  The  investigation 
of  such  diseases  is  naturally  of  great  importance,  as  afiecting 
the  subject  which  we  have  now  in  hand.  Then,  too,  injuries, 
sections,  and  compressions  of  the  cord,  such  as  may  arise  from 
spinal  caries  or  tumors,  often  enable  us  to  draw  ^  aluable  con- 
clusions. 

Much  less  important  results  have  been  obtained  by  physio- 
logical experiments  on  animals  than  by  pathology.  The  neces- 
sary operations  are  comparable  to  patliological  processes  of  a 
ratlier  gross  character,  and  in  animals  we  know  very  little  of 
the  nature  and  source  of  the  severed  fibres,  for  tlie  reason  that 
tlieir  cord  has  not  been  so  thoroughly  investigated  as  in  the  case 
of  human  beings. 

It  is,  of  course,  beyond  the  pale  of  these  lectures  to  give 
even  a  short  summary  of  the  valuable  discoveries  which  we  owe 
to  pathological  research.  A  number  of  excellent  works  will 
afibrd  you  an  easy  introduction  into  this  part  of  our  subject. 

(173) 


174 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


I  will  mention  only  a  few  points  which  are  either  particu- 
larly important  or  have  been  established  beyond  a  doubt: — 

Diseases  of  the  pyramidal  tract  in  the  lateral,  and  apparent]y  in  the,  anterior 
columns  as  well,  cause  paresis  or  paralysis.  In  addition  to  this,  the  weakened  or 
paralyzed  muscles  are  in  a  condition  of  increased  tension,  have  a  tendency  to  con- 
tracture, and  are  abnormally  responsive  to  mechanical  irritants.  Wherever  you 
see  these  symptoms,  either  alone  or  mixed  with  others,  you  may  with  all  safety 
assume  that  the  pyramidal  tract  is  involved  in  the  disease. 


Hirnrindef 


Fig.  103. 
Diagram  of  innervation  of  a  muscle. 

ifot.  Nerv.,  Motor  nerve.  Muskul,  Muscle. 

Vorderhornzelle,  Ant. -root  cell.       Vuider- Wurzel,  Ant.  root. 
Hirnrinde,  Cortex  of  the  brain. 


Fig.  104. 
Localization  of  a  lesion  in  the  anterior 
horn  of  the  gray  matter  in  the  lumbar  en- 
largement, taken  from  a  two-year-old  child 
eleven  months  after  the  commencement  of 
the  disease.  A  large  lesion  in  the  right  and  a 
smaller  one  in  the  left  anterior  horn.  Sec- 
tions made  13,  23,30,  .36,  and  43  mm.  above  the 
fllium  terminale.    (From  Erb,  after  Roth. 


Diseases  of  the  posterior  columns  give  rise  to  symptoms  varying  according 
to  the  area  of  the  columns  involved.  Injuries  to  the  posterior  roots  at  their 
entrance  break  up  the  continuity  of  the  sensory  tract  which  runs  in  the  latter,  and 
cause  a  loss,  not  only  of  every  kind  of  sensation,  but  also  of  the  reflexes  whicli 
are  set  in  motion  by  the  sensory  tract.  The  reflexes  which  have  no  direct  con- 
nection with  conscious  sensation,  as  the  tendon  reflexes,  also  disappear.  Degen- 
erations of  the  posterior  columns,  which  do  not  injure  the  entering  posterior 
roots,  or  only  sliglitly  affect  them,  may  not  give  rise  to  any  serious  disturbance  of 
cutaneous  sensation,  but  the  muscle-sense  invariably  appears  to  suff'er,    The  main 


SPINAL    CORD  AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.        175 

purt  ol'  the  fibres  of  the  posterior  roots  which  run  in  these  eoliiinns  stund  in  some 
sort  of  rehxtion  to  this  sense.  The  motor  power  is  not  diminished  by  disease  of 
the  posterior  columns. 

If  the  gray  matter  of  the  anterior  horns  is  injured  by  a  pathological  process, 
there  appears  paralysis  of  the  related  muscles,  just  as  in  case  of  injury  to  the 
peripheral  nerves.  These  paralyses  are  followed  with  unusual  rapidity  by  atrophy 
of  the  atiected  muscles.  This  affection  resembles  the  ptüipheral  paralyses,  also, 
in  the  fact  that  the  paralyzed  muscles  react  to  the  electric  current  as  though 
tiieir  nerve-supply  had  been  cut  off.  We  think,  from  these  facts,  that  we  are 
justified  in  assuming  that  trophic  centres  for  the  muscles  and  nerves  are  situated 
in  the  anterior  horn.  The  section  experiment  proves  this.  No  matter  where  the 
anterior  root  is  severed,  be  it  flir  from  or  near  to  the  spinal  cord,  its  nerve  always 
<legenerates  toward  the  periphery  ;  while  the  posterior  root,  divided  in  like 
manner  from  the  cord,  remains  in  a  great  measure  normal  as  long  as  its  union 
with  the  spinal  ganglion  remains  undisturbed. 

If  the  fibres  of  the  anterior  roots  are  divided  in  the  lateral  columns  between 
tlieir  cells  in  the  anterior  horn  and  the  brain,  there  generally  results  only  paralysis 
and  no  atrophj^.  From  the  accompanying  diagram  (Fig.  103),  which  shows  the 
connection  between  the  central  and  peripheral  portions  of  a  motor  tract,  you  will 
easily  understand  the  reason  of  this  phenomenon. 

A  disease  situated  in  the  line  xac,  or,  rather,  in  the  fibres  represented  bj''  the 
line,  leads  to  paralysis.  If  it  interrupts  the  conductivity  of  the  fibres  above  the 
ganglion-cells  (at  a  or  x),  it- has  the  character  of  a  central  paralysis  without 
atrophy,  and  often  results  in  an  improvement,  or  even  a  cure,  probably  because 
other  tracts  act  vicariously  for  it.  If,  however,  the  tract  xac  is  interrupted  in  the 
ganglion-cell,  or  at  any  part  of  c,  then  not  only  paralysis  occurs,  but  the  paralyzed 
fibres  disappear,  and  the  muscles  supplied  by  them  become  atrophied.  In  this 
case  tliere  is  little  prospect  of  a  cure.  Occasionally,  after  long-protracted  disease 
of  the  part  x  a,  the  part  c  is  finally  involved.  This,  however,  is  rare.  A  break 
in  the  tract  at  a  leads  to  a  descending  degeneration  from  the  point  of  injury  to  the 
corresponding  anterior  horn.  The  trophic  centres  for  this  part  of  the  motor  tract 
must,  therefore,  be  sought  for  centrally  from  the  point  of  interruption,  probably 
in  the  corte.x.  As  an  example  of  paralysis  and  atrophy  following  disease  of  the 
anterior  horn,  I  will  cite  infantile  spinal  paralysis.  In  this  disease  tliere  occurs  a 
sudden  complete  paralysis  of  distinct  groups  of  muscles,  soon  followed  by  atrophy 
of  the  muscles  themselves.  An  examination  of  the  spinal  cord  reveals  disease-foci 
affecting  the  gray  matter  of  the  anterior  horns.  The  nerves,  too,  and  even  the 
anterior  roots,  gradually  l)ecome  atrophic.  The  spinal  cord  and  the  roots  present 
somewliat  the  appearance  shown  in  Fig.  105  A  and  B. 

We  are  not  yet  in  possession  of  a  sufficient  numl)er  of  accuiate  and  pains- 
iking  observations  to  enable  us  to  say  what  symptoms  will  result  from  a  disease 
of  the  gray  matter  of  the  posterior  liorns  A  comparison,  however,  of  the  cases 
of  tabes  dorsalis  in  which  it  was  affected,  and  of  those  in  which  it  was  not, 
make  it  probable  that  a  disease  affecting  tliis  region  would  give  rise  to  sensory, 
and  especially  to  trophic,  disturbances  of  the  skin.  In  the  vicinity  of  the  basal 
portion  of  both  anterior  and  i)oslerior  horns  there  must  be  situated  tracts  or 
centres,  which  stand  in  some  relation  to  the  trophic  innctrvation  of  the  skin  and 
it.H  blood-vessels.  We  must  also  look  in  this  region  for  the  mechanism  which 
underlies  tiie  temperature-sense. 


176 


LECTURES    ON    THE    CENTRAL    NERYOUS    SYSTEM. 


The  above-mentioned  functions  are  the  very  ones  that  sufter  most  in  a 
dilation  of  the  central  canal — syringomyelia — or  in  tumors  which  are  frequently 
situated  in  the  midst  of  the  gray  matter. 

After  this  short  excursion  into  the  domain  of  pathology  let 
us  return  to  the  consideration  of  the  structure  of  the  spinal 

cord.  At  its  up- 
per end  the  white 
fibres  which  com- 
pose it  are  arranged 
in  a  most  intricate 
manner.  The  ex- 
tent and  form  of 
the  gray  matter  is 
markedly  changed^ 
new  collections  of 
glia-  and  ganglion- 
cells  appear,  and  the 
familiar  appearance 
of  a  section  through 
the  spinal  cord  is 
greatly  changed. 
The  resemblance  is 
particularly  hard  to 
trace  just  above 
the  upper  terminus 
of  the  spinal  cord, 
where  the  inferior 
olivary  body,  a  gray, 
plicated  lamina,  rich 


Fig.  105  A  and  B. 


Spinal  cord,  with  acute  anterior  poliomyelitis,  43  years  after 
the  commencement  of  the  disease.  A.  Section  through  the  lum- 
bar enlargement,  both  anterior  horns  and  both  antero-lateral 
columns  strongly  atrophied,  more  so  on  the  left  than  on  the 
riglrt.  No  ganglion-cells.  B.  Section  thrcmgh  the  cervical  en- 
largement.    Left    anterior   horn    and    antero-lateral    column 

markedly   atrophied,    and    without  ganglion-cells.     Posterior       .  T  n 

horns  and  columns  normal  in  both  sections.     (After  Charcot      in  2"an2"ll0n-CellS, 

andJoffroy.)  ^'       ^  ' 

usurps  the  place  of 
the  lateral  cojumns  on  each  side,  and  the  central  canal,  trending 
continually  backward,  expands  into  the  fossa  rhomboidalis. 

The  series  of  sections  which  I  will  now  demonstrate  to  you 
is  intended  to  elucidate  the  transition  of  the  spinal  cord  into  the 
medulla  oblongata. 


SPINAL    CORD  AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.        DT 


Fig.  106  represents  a  section  through  the  cervical  medulla 
about  opposite  the  point  of  emergence  of  the  first  spinal  nerve. 
Its  general  appearance  reminds  us,  on  the  whole,  of  the  sections 
which  we  have  before  examined.  We  must  notice  three  points 
in  particular,  because  they  differ  from  what  we  have  hitherto 
seen.  One  is  the  peculiar  shape  of  the  posterior  horn.  It  con- 
sists only  of  a  thin  "  neck  "  united  to  its  most  dorsal  portion, 
which  at  this  level  is  markedly  thickened  by  admixture  with 
the  substantia  gelatinosa.  This  thickened  portion  is  called  the 
"head   of  the    posterior  horn."     The  substantia  gelatinosa  is 


A 

^<r 

.a«e^*l*k  \      Ji'iiterhom. 

Y  " 

M 

^^'^Prpc  rfticiharis. 

ty^-^-.-"-- ^ —  /v.  accessor. 

t                       I 

Si?^ 

[:^. 

-r;;-"0^flad.anf  X.cen.  I. 

Fio.  106. 
Section  through  the  uppermost  portion  of  the  cervical  cord. 

IlintKrhiirn,  Post.  horn.  Siilenhorn,  Lateral  horn. 

permeated  by  innumerable  fine  fibrils,  Avhich  may  possibly  have 
their  origin  in  it.  All  these  pass  to  the  region  lying  external  to 
the  substantia  gelatinosa  and  form  a  fasciculus,  which  extends 
to  the  periphery  of  the  spinal  cord  and  presents  a  somewhat 
crescentic  ajjpca ranee  on  cross-section.  This  fasciculus  ascends 
far  up  into  tlie  })()ns,  to  tlie  point  where  the  trigeminus  is  given 
off,  and  emerges  along  with  the  fibres  of  the  latter.  It  is  called 
the  ascending  root  of  tlie  fifth  nerve.  In  all  the  sections  which 
I  show  you  from  now  on  we  shall  see  this  cresc(;nt  of  nerve- 
fibres  and  the  substantia  gelatinosa  lying  median  to  it. 


ITS 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


Next,  you  will  notice  that  the  lateral  horns  are  strongly 
developed.  The  accessory  nerve  of  AYillis  arises  from  cells 
which  here  lie  at  their  base,  but  which,  at  higher  levels,  are 
situated  at  the  lateral  boundary  of  the  anterior  horns.  The 
root-fibres  of  this  nerve,  which  are  given  off  continuously  from 
the  level  of  the  sixth  cervical  nerve  up  to  the  commencement 
of  the  oblongata,  do  not  pass  straight  out,  as  might  be  supposed, 

Ng 


Fig.  107. 

Cross-section  of  medulla  oblongata  through  the  pyramidal  decussation.  Fpy,  pyra- 
midal column  ;  Cga,  anterior  horn  ;  Fa',  remains  of  anterior  column  ;  Ng,  nucleus  of  the 
funiculus  gracilis  ;  g,  substantia  gelatinosa;  XI,  accessory  nerve.     (After  Henle.) 

from  the  cut,  but,  on  the  contrary,  extend  upward  toward  the 
brain  and  then  bend  outward  at  an  angle  (Darkschewitsch). 
Only  the  horizontal  limb  of  this  angle  is  shown  in  the  section 
(106).  Please  notice,  too,  that  in  the  space  between  the  posterior 
;ind  anterior  horns  the  gray  matter  extends  out  into  the  lateral 
column  in  the  form  of  a  thick  net-work  of  fasciculi.  This  net- 
work is  insinuated  among  the  bundles  of  the  lateral  column,  and 
is  called  the  processus  reticularis. 


SPINAL    CORD  AND    COMMENCEMENT    OF    MEDULLA   OBLONGATA.       179 


Just  above  the  leVel  of  this  section  (Fig.  106)  begins  the 
peculiar  arrangement  of  fibres,  etc.,  which  go  to  make  up  the 
medulla  oblongata. 

We  found  two  pyramidal  tracts  in  the  spinal  cord, — one 
situated  in  the  anterior  column,  which  conducted  fibres  toward 
the  brain  which  were  added  to  it  from  each  nerve-root  on  the 

Ng 


Fig.  108. 

Bcction  through  medulla  oblongata  in  the  region  of  the  most  caudad  of  the  roots  of 
the  hypoglossal  nerve.  Pyramidaldecussation  almost  completed.  iVc,  nucleus  of  the 
funicuMiH  cuncatus ;  Xli,  hypoglossal  nerve.  All  other  marks  same  as  in  Fig.  107. 
(After  Henle.) 

opposite  side  of  the  cord,  and  a  second,  situated  in  the  lateral 
column,  which  received  fibres  from  the  anterior  horn  on  the 
same  side.  At  the  upper  end  of  the  spinal  cord  (Fig.  107,  Fpy) 
the  last-named  tract  forces  its  way  in  thick  bundles  through  the 
anterior  horn  of  its  own  side  and  reaches  the  opposite  anterior 
column.  Ilere  it  meets  with  the  anterior  pyramidnl  tract,  and 
from    this   point  the  crossed  and   the  uncnjssed   pyramids  are 


180  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

united  and  pass  upward  as  the  pyramidal  column.  The  posterior 
horns  move  more  to  the  front,  so  as  to  occupy  the  space  in  the 
lateral  columns  which  was  formerly  filled  by  the  pyramidal 
tracts. 

The  pyramidal  decussation  is  fully  completed  a  few  milli- 
metres above  this  point.  Both  the  anterior  direct  and  lateral 
indirect  pyramidal  fibres  are  united  into  a  thick  bundle  on  the 
ventral  side  of  the  cord,  which  now  bears  the  name  of  medulla 
oblongata.  This  is  clearly  shown  in  Fig.  108.  You  see  that 
the  ground-bundle  {Fa)  of  the  anterior  column  has  assumed  a 
position  dorsad  of  the  pyramids.  External  to  the  anterior  horn, 
which  has  been  cut  off  from  the  rest  of  the  gray  matter  by  the 
decussation  of  the  pyramids,  lies  a  small  gray  mass.  It  is  the 
commencement  of  the  inferior  olivary  body.  Higher  up,  the 
olivary  body  increases  greatly  in  size  and  occupies  a  large  share 
of  the  space  once  occupied  b}^  the  lateral  columns.  These  latter 
have  become  somewhat  less  ^.bundantly  supplied  with  fibres  since 
the  reticular  process  appeared  on  the  scene.  They  still,  how- 
ever, send  many  fasciculi  high  up  beyond  the  olivary  body  into 
the  reticular  processes.  On  account  of  the  continual  distribution 
of  fibres  to  small  gray  nuclei  situated  in  the  latter,  the  supply  of 
these  fibres  soon  becomes  exhausted  and  the  lateral  columns  can 
be  traced  no  farther. 

The  two  accompanying  figures,  taken  from  Plenle,  show 
beautifully  the  general  change  in  the  arrangement  of  fibres  and 
the  passage  of  the  lateral  columnar  pyramidal  tract  to  the  oppo- 
site anterior  columns.  The  severed  anterior  horns  can  be  traced 
still  farther  upward,  but  are  lost  at  about  the  level  of  the  pons. 

You  will  see  the  pyramidal  columns  in  the  anterior  part  of 
all  following  sections  lying  between  the  olivary  bodies.  (See  the 
figures  of  the  next  lecture.)  At  last  they  are  covered  in  and 
split  up  by  the  transverse  fibres  of  the  pons.  We  have  learned 
in  previous  lectures  how  they  re-appear  from  under  the  pons, 
and  pass  upward  in  the  pedunculi  to  the  internal  capsule.  We 
have  also  seen  tliat  a  break  in  the  conductivity  of  the  pyramid- 


SPINAL    C01{1)    AND    COMMENCEMENT    OF    MEDULLA  01}L0N(;ATA.       I8l 

tracts  situated  iu  tli(^  brain  was  followed  by  a  dosfx'iidiii<^'  de- 
^•(Micratioii,  wliicb  coidd  b(!  traced  tliroiigh  the  rrKididla  obloii<^ata 
into  the  oi)[)osite  [)ostero-lateral  column  and  the  anterior  f:olumn 
of  the  same  side. 

You  will  not  so  very  iiilVecjuently  have  o|)i)ortunitieH  to 
trace  out  the  (;üurse  of  the  pyramidal  cohunns  il',  in  auio[)sies  on 
old  cases  of  hemiplej^ia,  you  will  niake  se(!tions  throu<^h  the 
peibniculi,  tlie  pons,  the  medulla  obl()nü;ata,  and  th<'  sj)inal  cord. 
'I"h(!  grayish  pyramid  of  tin;  affected  side  can  generally  be  clearly 
distinguished  from  the  normal  white  one  of  th(;  sound  side.  In 
the  spinal  cord  there  will  be  also  a  gray,  discolored  spot  hi  the 
opi)osite  lateral  columiL 

In  that  region  ol'  the  spinal  cord  whi(-h  is  occupied  by  the 
pyramidal  der-ussation  th(M'(!  also  ap])ear  marked  changes  in  the 
post(,'rior  coliuiuis.  Gray,  ganglionic  masses  appear  first  in  the 
inner  and  llien  in  the  outer  division  of  llie  posterior  columns. 
These;  ai(!  llie  nuclei  funiculi  gracilis  et  funiculi  cuneati.  Tlu;se 
nurlei  become  blended  with  the  gray  matter  and  mat<;rially 
(•hange  its  configuration.  (In  Fig.  107  the;  first-mentioned  of 
the.se  nuclei  can  be  seen,  and  both  an^  shown  in  Fig.  108.) 
Apparently,  the  fibres  of  the  posterior  columns  gradually  termi- 
nate in  these;  nuclei.  From  the  latter,  however,  masses  of  fibres 
are  given  off,  which  pass  forward  through  the  gray  matter  and 
decussate  with  those  of  the  opposite  side  (above;  the  pyramidal 
decussation).  The  fibres  pass  later  to  the  fillet,  and  the  upper 
j)yramidal  decussatioii  has  also  been  called  the  decussation  of  the 
fillet. 

It  is  not  easy  to  demonstrate;  beyond  a  de)ubt  the  existence 
of  the'  d(;cussation  of  the»  lemniscus  in  the  adult  organ.  All 
df)ubt  ceases,  however,  if  we  examine  sections  through  the  me- 
didla  oble)ngata  of  e;mbryos  in  the;  seve-nth  month.  In  this  case 
ibe  d(;e;ussating  me'elullary  pyramielal  fibre's  are  not  pre.'sent  to 
l)lur  the  cle;anie;ss  of  the;  image«,  and  the  fibres  of  the  pe)ste;rie)r 
e-olumns,  which  alone  are  me;dullary,  staiiel  e)iit  promin(;ntly  and 
cannot  ])e'  mistaken.     At  first,  oidy  the«  fibre's  fie)m  the  nuclei  of 


182 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


Burdach's  column  can  be  made  out,  but  later,  in  the  ninth  foetal 
month,  the  decussation  of  the  fibres  from  the  nuclei  of  GoU's 
tract  can  also  be  seen. 

Let  us  compare  the  accompanying  cut  with  Figs.  107  and 
108.  Behind  the  central  canal  lies  the  gray  matter,  which,  at 
this  level,  has  become  very  much  expanded  laterally.     In   the 


'//:-. 


'■«,,    Suht-tantia 


'% 


\  V.N!>V«i'  •■       N'        •     /,'  //■'^ .^^\^      ■'     Horn 


fyrar 


Fig.  109. 
Section  through  the  commencement  of  the  medulla  oblongata  taken  fi-om  a  human 
embryo  of  the  20th  week.  Notice  the  tracts  from  the  columns  of  Burdach  to  the  decus- 
sation of  the  fillet,  and  the  flbrse  arciformes  externae  posteriores  from  the  column  of 
Goll,  which  will  be  described  later  on.  Observe  the  situation  of  the  dh'ect  lateral  cere- 
'bellar  tract. 


Kleinhirn  Bahn.  Cerel)ellar  tract. 
Vorderhorn,  Anterior  horn. 


Oliv.-Zwineh.-ScMcht,  Inter-olivary  layer. 
Vorder-Strang-Rest,  Remains  of  anterior  column. 


funiculi  gracilis  et  cuneati  their  respective  nuclei  have  appeared, 
and  both  are  continuous  with  the  gray  matter.  External  to  these 
lies  the  substantia  gelatinosa  of  the  posterior  horns,  surrounded 
by  a  thin  stratum  of  medullary  fibres  (ascending  root  of  fifth 
nerve).  The  space  in  front  of  them,  which,  in  Fig.  108,  is  oc- 
cupied by  the  dark  pyramidal  fibres,  appears  clear  because  these 
fibres  have  not  yet   become  medullary.     The  remnant  of  the 


SPINAL    CORD    AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.       183 

antero-lateral  column  and  the  direct  lateral  cerebellar  tract  at 
the  periphery  of  the  lateral  column  have  become  medullated. 


Fig.  no. 

Rection  throuff!)  tho  nifdulla  ol>lniieata  of  an  embryo  of  the  20th  week.  The  medul- 
lary fibres  an-  .stameü  with  liieiiiatoxvlin.  The  left  iiiter-olivary  layer  and  the  ascending 
root  of  the  trigeminus  are  not  showi'i.  In  tlie  restifonn  body  only  that  portion  which  is 
derived  from  the  spinal  cord  is  medullary.  Fibrie  arci formes  =  fi brae  arciformes  externae 
anteriores.  The  jiosterior  external  arciform  filires  can  be  seen,  outside  and  above,  be- 
tween the  restiforni  body  aii(l  the  posterior  column. 

BintTftranfi.  PoBt«rior  cohimn.  Jlint.  Ni^ben  Otioi;  Posterior  accessory  olivary  process, 

/nn.  Neben  Olive,  Internal  accessory  clivary  process.  Oliven  Zu:inrlien.irliirJil,  Inter-olivary  layer. 

Seitenttr.  Balm,  Lateral  (cerebellar)  tract. 


We  now  see  fibres  arising  from  tlie  nuclei  of  tlic  posterior 
cohimns,  which  pass  in  a  curve  tlirough  the  gray  matter  (fibrae 
arciformes  interna)),  decussate  in  front  of  the  central  canal,  and 


184  LECTURES    OX    THE    CENTRAL    NERVOUS    SYSTEM. 

lie  iu  a  tliick  stratum  dorsad  of  the  pyramids,  which  have,  at 
this  level,  completed  their  decussation.  The  region  in  which 
they  lie  is  the  one  which  was  occupied  by  the  antero-lateral 
columns  in  the  spinal  cord.  The  main  mass  of  crossed  sensory 
tracts  which  ascended  in  the  latter  is  crowded  backward  and 
outAvard  by  these  new-comers.  Thus,  the  now  united  crossed 
sensory  tract  fills  up  all  tlie  space  between  the  olivary  bodies 
(olivae  inferiores).  The  latter  are  gray  masses,  which  first  appear 
in  the  medulla  oblongata  at  this  level.  The  higher  we  pass  in 
the  medulla  oblongata,  the  fewer  fibres  are  there  found  in  the 
posterior  columns.  Gradually,  all  of  them  pass,  by  way  of  the 
arciform  fibres,  to  the  decussation  of  the  lemniscus,  and  extend  to 
the  opposite  side  near  the  middle  line,  where  they  form  the  inter- 
olivary  layer,  or,  as  we  wül  call  it  from  now  on,  the  layer  of  the 
fillet.    The  fibres  of  this  layer  pass  to  the  fillet  of  the  mid-brain. 

It  has  been  frequently  claimed  that  the  fibres  of  the  pos- 
terior columns  do  not  follow  this  course,  but  rather  pass  into  the 
olivary  bodies,  and  from  there  through  the  posterior  peduncles 
of  the  cerebellum  into  that  body.  My  investigations  have 
shown,  however,  that  they  all,  or  nearly  all,  follow  the  course  I 
have  described.  At  the  embryological  period  of  which  I  was 
speaking,  both  the  olivary  bodies  and  their  whole  vicinity  are 
destitute  of  medullary  fibres.  We  can  therefore  prove,  in  the 
most  convincing  manner,  that  the  fibres  of  the  posterior  columns 
have  no  connection  whatever  with  them,  but  only  pass  through 
them.  Fig.  110  represents  a  section  through  the  same  foetal 
oblongata  shown  in  Fig,  109.  This  section  is  made  somewhat 
higher  up  than  the  latter,  and  shows  clearly  the  point  of  which 
I  speak.  You  see  that  the  fibres  pass  through  the  olivary 
bodies  (which  at  this  level  have  the  appearance  of  plicated 
medullary  laminae)  to  the  decussation  in  the  middle  line  (^raphe^ 
continuation  of  the  decussation  of  the  fillet). 

Fig.  Ill  is  a  diagram  of  the  course  of  the  sensory  fibres. 
Let  us,  with  the  aid  of  this  diagram,  trace  out  the  course  of  the 
separate  tracts,  and  ascertain  what  location  in  the  medulla  is 


SPINAL    CORD   AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.        185 


assigned  to  each.  Please  notice  in  this,  as  in  the  hist  figure,  how 
tlie  tracts  which  decussated  in  the  spinal  cord  and  those  wliich 
ascended  directly  are  united  to  form  a  single  body.  We  have 
now  met  with  two  important 
decussations, — that  of  the  pyra- 
mids and  that  of  the  lemniscus. 
The  former  is  composed  of  motor 
fibres,  while  the  latter  contains 
the  sensory  tracts. 

There  are  formed,  therefore, 
two  new  large  tracts  of  fibres, 
which  lie  in  the  ventral  portion 
of  the  oblongata,  viz.,  the  pyra- 
midal columns,  and,  dorsad  of 
these,  the  layer  of  the  fillet,  or 
inter-olivary  layer.  We  shall 
find  them  both  occupying  the 
same  relative  positiov^  as  far  up 
as  the  corpora  quadrigemina. 

The  transverse  area  of  tlie 
layer  of  the  fillet  is,  in  adults, 
much  richer  in  fibres  than  is 
shown  in  the  illustrations,  which 
have  been  prepared  from  sec- 
tions taken  from  the  foetus.  In 
the  latter  none  of  the  sensory 
fibres  from  the  antero-latcral 
columns  are  medullary,  and  only 
those  bundles  which  come  from 
the  nuclei  of  the  posterior 
fobimns  can  be  seen. 

The  whole  configuration  of  the  section  is  changed  by  these 
two  decussations.  In  addition  to  this  the  gray  matter,  as  I  will 
presently  show  you,  varies  its  outline.  New  masses  of  gray 
matter  appear  in  the  oblongata.     We  have  already  met  three 


Fk;.  hi. 
Diat!;raiu  of  the    course   of   the  sensory 
tract  from  the  posterior  roots  to  the  medulla 
ohlongata. 

Kl'inhirn-Seiten  B..  lateral  cerebellar  tract. 
Vonlcr-Seitennlr.,  Antero-lateral  column. 


186 


LECTURES    ON   THE    CENTRAL    NERVOUS    SYSTEM. 


of  these  on  each  side, — the  two  nuclei  of  the  posterior  columns  * 
and  the  olivary  body.     The  greatest  difference  is  in  the  outer 
conformation  of  the  section.     The  fibres  of  the  posterior  columns 


tniiearm 


JV'achkirn.  :^' 


j^eis^njiij^. 


Fig.  112. 
The  hind-  and  after-  brains  opened  by  removing  their  roof.    The  velum  medulläre 
anticum  and  the  cerebellum  can  still  be  seen.    The  velum  medulläre  posticuni  has  been 
removed  along  the  dotted  line  a  b: 


Bindearm,  Peduncle. 
Hinterhirn,  Hind-brain. 
Hirnschenkel,  Pedunc.  cerebri. 


Kleinhirn,  Cerebellum. 
Mittelhim,  Mid-brain. 


Nachhim,  After-brain. 
Rückenmark,  Sp.  cord. 
Zwischenhim,  Inter-brain. 


are  pushed  gradually  forward  by  the  interposed  nuclei,  so  that 
at  last  the  latter  are  wholly  uncovered  and  lie  almost  free  on 
the    dorsal    surface  of  the    medulla.      The    posterior   columns 


SPINAL    CORD    AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.       187 

diverge  somewhat  in  the  reoion  of  the  obloiiiiata,  so  that  the 
central  gray  matter  lies  exposed  on  the  po'sterior  surface  of  the 
spinal  cord.  Only  a  thin  membrane  of  gi'ay  matter  divides  the 
central  canal  from  the  free  surface.  This  canal  expands  along' 
with  the  diverging  posterior  columns,  and  from  now  on  is  called 
the  fourth  ventricle.  The  thin  membrane  which  covers  it  is 
called  the  velum  medulläre  posticum,  and  is  continuous  anteriorly 
with  the  cerebellum.  In  the  sagittal  section,  Fig.  66,  you  can 
see  how  the  hind-brain  roof  is  formed  by  the  velum  medulläre 
posticum,  the  cerebellum,  and  the  velum  medulläre  anticum. 
Just  at  the  commencement  of  the  fourth  ventricle  is  an  opening- 
through  the  velum  medulläre  posticum,  which  leads  from  the 
outside  into  the  ventricular  cavity.  It  '\ß  the  previously-described 
foramen  of  Magendi.  Through  this  the  fluid  in  the  ventricles 
communicates  w-ith  that  which  lies  outside  between  the  pia  and 
the  medulla,  and,  in  the  cavity  of  the  arachnoid,  bathes  the 
whole  central  nervous  system. 

In  Fig.  112  this  whole  roof  is  removed,  so  that  we  are 
looking  directly  into  the  fourth  ventricle.  Its  floor  is  bounded 
behind  by  the  diverging  posterior  columns  and  in  front  by  the 
anterior  cerebellar  peduncles,  which  converge  toward  the  corpora 
quadrigemina.  This  condition  of  things  has  given  it  the  peculiar 
shape  from  which  it  has  received  its  name, — fossa  rhomboidalis. 

The  posterior  view  of  the  oblongata  (Fig.  112)  shows  that 
the  posterior  columns  disappear  above,  and  that  the  posterior 
cerebellar  peduncles,  the  corpora  restiformia  (see  below)  take 
their  place.  The  enlargement  in  the  upper  portion  of  the  mnor 
posterior  column  is  called  the  clava,  and  is  caused  by  the  nucleus 
funicvdi  gracilis. 

A  front  (ventral)  view  of  the  medulla  oblongata  (Fig.  113) 
shows  first  the  thick  pyramidal  columns  ascending  from  the 
spinal  cord.  External  to  them,  imb(>dded  in  the  prolongntions 
of  the  lateral  columns,  are  two  good-sized  enlargements. — tlie 
olivary  bodies.  Not  far  above  them  the  thick  masses  of  fibres 
which  constitute  the  pons  pass  across  in  front  of  the  pyramids. 


188 


LECTURES    ON    THE    CENTRAL    NERVOUS   SYSTEM. 


In  the  prolongation  of  the  line  of  exit  of  the  anterior  roots, 
between  the  olivary  bodies  and  the  pyramids,  the  hypoglossal 
nerve  {XII)  emerges  from  the  medulla  oblongata.  The  spinal 
accessory  nerve  of  Willis  (X/)  arises  by  numerous  radicles, 
which  are  given  off  along  the  side  of  the  cervical  cord,  and 
high  up  in  the  oblongata,  external'  to  the  olivary  bodies.  Above 
and  in  line  with  it  emerge  the  vagus  (X)  and  the  glosso- 
pharyngeal  {IX).     Laterally,   close  behind   the   fibres  of  the 


M.cerv, 


Fig.  113. 

Medulla  oblongata,  pons,  cerebellum,  and  pedunculus  cerebri  seen  from  in  front.    To 

show  the  origin  of  the  cranial  nerves. 

pons,  are  given  off  the  acoustic  (  F///)  and  the  facial  nerves 
(  VII).  The  sixth  cranial  nerve,  the  abducens,  lies  internal  to  the 
point  of  origin  of  the  two  last  mentioned.  The  trigeminus  (  V) 
arises  from  the  depths  of  the  pons.  The  origins  of  the  trochlear 
{IV)  and  the  oculo-motor  (///)  have  already  been  given.  The 
first  emerges  from  the  velum  medulläre  posticum  behind  the 
corpora  quadrigemina,  and  the  second  from  the  ventral  surface 
of  the  pedunculi  cerebri. 


Spinal  cord  and  commencement  of  medulla  oblongata.     189 


\\'(^  lel't  oft'  studying-  tlio  isectiou  of  the  oblongata  at  the 
point  where  the  central  canal  expands  mto  the  rhomboidal  fossa. 
The  first  nuclei  of  tlie  cranial  nerves  had  begun  to  appear 
below  this  point.  The  fibres  of  the  acoustic  arise  from  cells  in 
the  lateral  portion  of  the  anterior  horn.  From  a  point  some- 
what ventrad  pf  the  latter,  perhaps  representing  the  position  of 
the  former  anterior  liorn,  arise  the  fasciculi  of  the  hypoglossal 
ner\-e. 

This  is  diagrammatically  shown  in  the  accompanying  figure. 


FKi.  n4. 

Section  tliroiiKli  tlie  itici1u11;i  oldongata  at  the 'level  of  tlie  most  posterior  roots  of  the 
h ypofrlossiil  nerve.    ( 1  )ia};ranimatic. ) 

All"  II,  sir.  K'-ni'iit,  From  tlio  nuilei  iif  tlie  finsterifir  columns.  Anx  l}Url-ni»inrh;  Frnin  tlie  spinal  PorJ. 

ly.ifli.  liiiltii,  Lateral  cerebellar  trait.  JUnliihoni,  I'osUM'ior  Imrn.  HiiiliTKlriiniif,  l'ciütericir  eolunins. 

.S'-liIri/',  Fillet.  Viiiili  r-Sr'ilinhtirn,  Anteni-lateral  horn. 

If.  looking  at  this  diMgrnm.  you  will  remember  tliat  tlie  central 
canal  broadens  out  jdong  witli  I  he  diverg(>nce  of  the  posterior 
columns  and  becomes  tlie  fourth  \entricle.  you  will  ensily  under- 
stMiid  thnt  nil  nerve-nuclei  developed  in  the  floor  of  the  ventricle 
nbove  this  j)oiiit  must  lie  on  the  floor  of  the  rhomboidal  fossa. 
Tlie  following  rut  (l''ig.  11 5)  shows  this  clearly.  I'iXternal  to 
the  nerve-nuclei  lie  tlie  ])osterior  columns  (now  nearly  devoid 
of  fibres),  with  tbeir  respective^  nuclei.  TIk;  postxn'ior  horn, 
recognizable  by  the  substantia  gelatinosa  of  its  head,  is  entirely 


190 


LECTURES   ON   THE   CENTRAL   NERVOUS   SYSTEM. 


severed  from,  the  compact  portion  of  the  gray  matter.  The 
basal  portion  of  the  lateral  horns,  from  which  arise  the  fibres  of 
the  motor  accessory,  are  also  separated  from  it  a  short  distance 
above  the  level  of  this  section.  The  latter  continues  ventrad  of 
the  former,  as  an  independent  column  of  gray  matter,  rich  in 
ganglion-cells,  high  upward  into  the  pons ;  and  wjien  the  fibres 
to  the  accessory  are  no  longer  given  off  it  sends  fibres  to  the 


Fig.  115. 

Section  through  the  medulla  oblongata  at  the  level  of  exit  of  the  vagus  nerve. 

(Diagrammatic .) 

Hinterhorn,  Posterior  horn.  Hinterx/ni'iige,  Posterior  cohimns. 

3fot.  Vagus  etc.  Kern,  Motor  vagus,  etc.,  nucleus.  OHv.  Zwhch.  ScMcht.,  Inter-olivary  layer. 

fSchhifenfa/iern,  Fibres  of  fillet.  Seitc.nstranfil-ern,  Nudeui;  of  lateral  column. 

Vni-derhornrent,  Remnant  of  anterior  horn. 

vagus  (and  hypoglossal  X ),  which  at  first  pass  dorsad  and  then 
bend  back  to  the  respective  nerves  (motor  vagus,  etc.,  nucleus). 
Still  higher,  we  meet  it  as  the  nucleus  of  the  facial  nerve.  You 
will  notice  that,  with  the  exception  of  the  hypoglossal  and  the 
nerves  to  the  ocular  muscles,  all  the  motor  fibres  of  the  cranial 
nerves  originate  in  this  upward  prolongation  of  the  basis  of  the 
lateral  horns  of  tlic  spinal  cord. 


SnXAL   CORD    AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.       191 

Please  notice  in  Fig.  115  the  position  of  the  remnant  of  the 
anterior  horn  and  the  great  increase  in  volume  of  the  olivary 
bodies.  When  the  lateral  horn  is  divided  from  the  rest  of  the 
gray  matter  there  appears,  at  the  point  where,  lower  down,  the 
posterior  liorn  was  attached  (a  region,  therefore,  which,  in  the 
spinal  cord,  was  occupied  by  the  nuclei  of  sensory  nerves),  a  large 
new  nucleus  with  spindle-shaped  cells  much  lilie  those  of  the 
posterior  horns.  This  is  the  sensory  nucleus  of  the  vagus.  It 
lies  on  the  floor  of  the  rhomboidal  fossa,  internal  to  the  ala 
cinerea  (Fig.  112),  and  extends  forward  to  about  the  middle  one 
of  the  transverse  white  lines  which  you  see  crossing  the  fossa. 
From  this  anterior  end  arises  the  glosso-pharyngeal  nerve.  The 
nucleus  of  the  glosso-pharyngeal  is  not  sharply  divided  from 
tliat  of  the  vagus.  AVe  now  see  that  there  are  two  nuclei  for 
tlie  vagus, — a  vcnitral  one.  which,  from  its  situation  (prolongation 
of  a  portion  of  the  anterior  horn)  and  from  its  cells  (multipolar 
Mitli  axis-cylinders),  we  judge  to  be  motor,  and  a  dorsal  ouo, 
wliich,  from  its  situation  in  the  prolongation  of  the  gray  matter 
at  the  base  of  tlie  posterior  horn  and  from  its  structure,  we  take 
to  be  sensory.  Tlie  first  mentioned  of  these  is  also  called  the 
nucleus  aml)iguus.  The  fibres  arising  from  it  all  pass  dorsad, 
and  unite  and  turn  at  angle  to  join  the  straight  sensory  root, 
which  is  much  larger.  (See  Fig.  115.)  Besides  these  two  nuclei 
the  vagus  receives  fibres  from  at  least  two  other  regions.  There 
is  a  small  fasciculus  wliich  can  be  traced  from  the  cervical 
medulla  up  to  the  point  in  the  oblongata,  where  the  last  roots 
of  th(^  glosso-pharyngeal  arise.  On  its  median  side  is  a  column 
of  gelatinous  substance  containing  a  few  cells.  The  fibres  from 
tlK'se  all  pass  to  the  fasciculus  just  mentioned.  At  the  level  of 
the  vagus-roots  it  begins  to  send  oft"  fibres  to  them,  and  this  it 
does  to  all  the  roots  of  the  vagus  and  the  glosso-pharyngeal. 
This  fasciculus  is  called  the  common  ascending  vago-pharvngeal 
root.* 
,       It  can  be  seen  in   Figs.  110  jiiid  1  LS,  dorsad  of  the  \agus- 

•  (jiierkc's  lespiratory  luiiMlle. 


192 


LECTURES    OX    THE    CENTRAL    NERVOUS    SYSTEM. 


roots.  In  addition  to  this  the  vagus  and  glosso-pliaryngeal 
apparentlv  receive  a  descending  root.  It  arises  in  the  cere- 
belhim.  where  we  met  it  under  the  name  of  direct  sensory 
cerebellar  tract.  These  particular  fibres,  passing  from  it  to  the 
vagus,  are  hard  to  demonstrate  in  the  human  being.     Apparently 


,}hLcleusX 


Pibrae.  propriae 
TtiicleiXn- 


lfu:leu3  XII. 


FibraeafrerenUa 
ruhclei  Xß 


-  -NtuUllsXHRoRo- 


•Kervus  XII 


Fir.  116. 
Frontal  seotion  tlirouo;li  the  niulins  <it  tlie  hypoglossal  nerve.     (After  Korh.) 


the  sensory  tibres  arise  from  the  ganglion  juglare  and  extend 
from  it  toward  the  cerebrum  (His)  just  like  the  sensory  spinal 
nerves.  The  before-mentioned  sensory  nucleus,  therefore,  is 
their  second  terminal  point.  ]\Iany  curving  fibres  enter  i^ 
ventral  side.     By  embryological  methods  we  have  succeeded  in 


SPINAL    CORD    AND    COMMENCEMENT    OF    MEDULLA  OBLONGATA.       193 

showing  that  these  fibres  come  from  the  opposite  layer  of  the 
fillet.  Thus  the  diagram  of  a  sensory  spinal  nerve  will  also 
represent  the  course  of  the  sensory  vagus  (and  the  glosso-phar- 
yngeal  as  well) — nerve,  first  nucleus  in  spinal  ganglion  ;  root, 
second  nucleus  (sensory  vagus-nucleus),  crossed  ascending 
central  tract. 

The  nucleus  of  the  hypoglossal  consists  of  several  collec- 
tions of  ganglion-cells,  which  are  united  by  a  fine  net-work. 
From  the  large  multipolar  cells  are  given  off  fine  processes, 
which  converge  to  form  a  number  of  nerve-rootlets. 

From  the  nucleus,  just  as  from  the  anterior  horn,  are  devel- 
oped afferent  fibres,  which  pass  over  across  the  median  line. 
Tliey  do  not  continue  their  course  far  on  the  opposite  side,  but, 
after  decussating,  run  toward  the  brain  in  the  raplte  and  become 
united  with  other  fibres  (from  the  facial  nucleus)  in  the  pons. 
The  whole  fasciculus  then  passes  into  the  pyramid  of  the  crusta. 
Although  this  course  differs  somewhat  from  that  of  the  central 
motor  tracts  in  the  spinal  cord,  still  it  is  essentially  the  same — 
root,  nucleus,  crossed  tract  to  the  pyramids. 

The  net-work  connecting  the  diiferent  divisions  of  the  hypo- 
glossal nucleus  is  of  peculiar  interest ;  we  meet  with  nothing 
Hke  it  in  any  of  the  other  nerve-nuclei.  We  should  also  notice 
that  tliere  is  no  other  nerve  whose  fibres  must  act  so  harmoni- 
ously and  so  nearly  at  the  same  instant,  as  tlie  fibres  of  the 
liypoglossal  in  the  act  of  swallowing.  Inasmuch  as  I  have  been 
compolk'd  to  place  before  you  to-day  figures  whicli  are  larg(?ly 
diagrammatic,  it  will  be  well  for  you,  at  tlic  close  of  this  lectnre. 
to  study  carefully  the  accompanying  representation  of  the  hypo- 
glossal nucleus.  It  was  drawn  by  Koch,  in  all  its  wealth  of 
cells  and  fibres.  He  it  was  who  first  described  the  net-work. 
Ventrad  of  this  nucleus  lies  another  collection  of  cells  (Roller's 
hypoglossal  nucleus),  from  which,  however.  I  do  not  think  that 
hypoglossal  fibres  arise ;  at  least,  not  in  man. 

The  pyramidal  decussation  was  discovered  as  early  as  1710,  l»y  Francois 
Petit.     The  olivary  bodies  were  first  described  by  Vieussens.     The  macroscopic 


194  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

changes  in  configuration  from  tlie  spinal  cord  to  the  medulla  oblongata,  particu 
larly  those  relating  to  the  surface,  were  first  described  by  Santorini,  Reil,  Burdach, 
and  Rolando.  The  nuclei  arciformes  and  the  anterior  arciform  fibres  which  cover 
tliem  were  first  accurately  described  by  Arnold,  who  named  them  "the  anterior 
pons."  The  strise  acusticse  were  discovered  by  Picolhomini.  Even  in  the  pre- 
microscopic  period  there  was  an  active  dispute  as  to  their  relation  to  the  acoustic 
nerve.  Real  light  was  first  thrown  on  the  structure  of  the  medulla  oblongata  by 
Stilling,  Kölliker,  Meynert,  Scliroeder  von  der  Kolk,  and  Deiters.  In  later 
years  investigations  directed  more  particularly  to  the  nerve-nuclei  have  been 
instituted  by  Gudden,  Roller,  Freud,  Laura,  Duval,  Koch,  Darkschewitsph,  and 
others. 


LECTURE  XI. 

'CHE  MEDULLA  OBLONGATA  AND  THE  TEGMENTUM  OF  THE  PONS. 

Gentlemen  :  In  the  last  lecture  we  learned  how  the  con- 
formation of  the  oblongata  was  brought  about  by  the  peculiar 
alteration  in  the  relative  position  of  vast  tracts  of  fibres,  by  the 
a[)pcarances  of  new  nuclei,  and  by  the  disappearance  of  the 
posterior  columns.  We  have,  however,  failed  to  trace  a  number 
of  tracts  upward  from  the  spinal  cord,  and  to  these  we  will  now 
turn  our  attention.  The  posterior  columns  have  found  their 
indirect  prolongation  in  the  layer  of  the  fillet,  and  to  this  layer 
also  have  passed  those  motor  fibres  which  ascended  in  the  antero- 
lateral columns.  The  pyramidal  tracts  of  the  anterior  and 
lateral  columns,  now  united,  lie  on  the  ventral  surface  as  the 
thick  pyramids  of  tlie  oblongata.  The  direct  lateral  cerebellar 
tract  maintains  its  position  on  the  outer  periphery  far  up  into 
the  level  of  the  olivary  bodies.  At  that  point  its  fibres,  still 
gently  ascending,  begin  to  pass  dorsad  to  the  cerebellum.  Here 
tliey  form  the  nucleus  of  a  large  bundle  which  appears  at  this 
level, — the  posterior  cerebellar  peduncle,  or  cor[)us  restiforme. 

The  restiform  body  arises  externally  to  the  upper  extremity 
of  the  posterior  columns,  and  at  this  point  is  made  up  principally 
of  the  direct  lateral  cerebellar  tract.  To  this  are  added  the 
posterior  external  arciform  fibres,  which,  as  you  see  from  Figs. 
117  and  110  (above  and  to  the  left),  pass  to  them  from  the  pos- 
terior columns  along  tlie  outer  and  posterior  periphery  of  the 
medulla  oblongata.  Fibres  are  also  added  to  them  from  in 
front.  These  are  the  anterior  external  arciform  fibres,  which 
originate  a))parently  in  the  layer  of  the  fillet  between  the 
olivary  bodies,  and  are  really,  therefore,  continuations  of  the 
crossed  posterior  columns.  These  fibres  approach  the  surface 
near  the  middle  line  in  front,  extend  around  past  the  ])yramids, 
and  run  outward  and  backward  to  the  restiform   bodies.     They 

(li)"^) 


196 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


have  also  been  called  the  pyramidal  arciform  fibres  (Fig.  113, 
front  view).  They  inclose  a  small  nucleus, — the  nucleus  arci- 
formis  (Fig.  118).  Thus  there  pass  to  the  restiform  body  from 
the  spinal  cord,  1,  the  direct  cerebellar  tract;  2,  fibres  of  the 
posterior  column  on  the  same  side;  3,  fibres  probably  from  tne 
opposite  posterior  column.* 


Fig.  117. 
Section  through  the  medulla  oblongata  of  an  embryo  of  the  twenty-sixth  week. 


Hinter-Horn,  Post.  horn. 

Kleinhirn  Bahn,  Cei'ebellar  tract. 

Oliv.  Zwisch.  Schicht,  Inter-olivary  layer. 


Seitenstrang,  Lateral  column. 
Vorder-Horn,  Anterior  horn. 
Vorder-Strang-Rext,  Remnant  of  anterior  column. 


In  the  embryonal  period  depicted  in  Fig.  110,  only  the 
fibres  from  the  spinal  cord  are  medullary.  Thus  we  can  clearly 
distinguish  the  extent  and  location  of  this  portion  of  the  pos- 
terior cerebellar  peduncle.  The  dififerent  arciform  fibres  are 
also  shown  in  Fig.  118.  , 

The  restiform  bodies,  however,  contain,  besides  the  fibres 
from  the  spinal  cord,  a  second  and  much  larger  system,  which 

*  The  fibres  mentioned  under  the  heading  3  become  medullary  months  before  the 
pyramids  and  olivary  bodies,  probably  at  the  same  time  as  the  posterior  columns. 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS. 


197 


must  be  distinct  from  the  former,  because  it  becomes  medullary 
at  a  much  later  period.  These  are  the  fibres  from  the  opposite 
olivary  bodies.  Inasmucli  as  they  come  from  the  cerebehum 
and  can  be  traced  no  farther  d^vnward  than  the  olivary  bodies, 
let  us  irive  them  the  name  of  cerebello-olivarv  fibres  of  the  resti- 
form  body.  It  is  only  after  tlie  addition  of  these  fibres  tliat  the 
posterior  cerebellar  peduncle  becomes  a  larger  structure  than 
that  shown  in  Fig.  110,  when  it  consisted  only  of  the  fibres 
from  tlie  spinal  cord. 

The  olivary  body,  a  medullary 
structure  whose  wavy  outline  you 
have  seen  on  many  of  the  previous 
figures,  consists  of  a  mass  of  neu- 
roglia, in  whicli  are  imbedded  in- 
numerable small  ganglion-cells. 
What  the  relation  is  between  these 
cells  and  tlie  nerve-fibres  which  run 
to  the  olivary  bodies  is,  it  is  impos- 
sible to  state. 

Large  masses  of  fibres  emerge 
from  the  resti  form  body,  and  sur- 
round the  olivary  process  externally 
in  front  and  behind.  They  pass 
through  its  medullary  lamina,  and  in 


Origin  of  the  spinal-cord  portion  of 
the  restiform  body.  Most  or  all  of  the 
fibres  end  in  the  vermis. 


Binter-Strüiige,  Post,  columns. 
Khinh.  S.  B.,  Lateral  cerebellar  tract. 


the  interior  are  gathered  into  a  thick 
bundle  of  nerve-fibres,  which  emerges  from  the  hilus  of  the 
olivary  body,  crosses  the  raphe^  and  can  be  traced  into  the  olivary 
body  of  the  opposite  side.  If  one-half  of  the  cerebellum  is 
destroyed,  the  opposite  olivary  body  degenerates.  Dorsad  of  the 
olivary  body,  in  the  vicinity  of  the  substantia  reticularis,  a  num- 
ber of  fasciculi  pass  upward  in  the  tegmentum,  in  company  \vith 
fibres  which  are  given  ofi"  from  the  net- work  surrounding  the 
ganglion  (Bechtf.'rew's  central  tegmental  tract,  Stilling's  remnant 
of  tlie  lateral  column). 

The  cerebello-olivary   tract  of  the  restiform  body  has  its 


198  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

principal  source  in  the  outer  side  of  the  fleece.  This,  again,  is 
connected  with  the  anterior  cerebellar  peduncle  by  the  nucleus 
dentatus  cerebelli,  which  it  surrounds.  Thus,  we  can  easily 
imagine  that  the  olivary  body,  tli«  opposite  restiform  body,  the 
jfleece,  the  anterior  cerebellar  peduncle  and  the  red  nucleus, 
again  of  the  opposite  side,  form  a  separate  system  of  fibres. 
Many  observations,  particularly  those  gained  by  experiments  on 
animals,  go  to  show  that  this  system  is  of  great  importance  in 
maintaining  equilibrium. 

Many  investigators,  adopting  Meynert's  views,  are  of  the 
opinion  that  the  cerebello-olivary  tract  is  the  continuation  of  the 
fibres  of  the  posterior  columns,  which  pass,  so  they  claim,  into 
the  olivary  body,  and  then  emerge  from  it  to  reach  the  cerebel- 
lum by  way  of  the  restiform  body.  We  have,  however,  pre- 
viously seen  that  the  posterior  columns,  while  they  do  indeed 
reach  the  vicinity  of  the  olivary  bodies,  through  the  arcuate 
fibres,  and  even  in  many  instances  pass  directly  through  them, 
yet  have  nothing  in  common  with  the  olivary  fibres  proper,  but 
terminate  in  the  layer  of  the  fillet. 

At  those  levels  of  the  oblongata  where  the  nucleus  of  the 
vagus  is  situated,  most  of  the  fibres  from  the  spinal  cord  have 
already  entered  the  restiform  body.  At  this  level,  too,  the 
latter  has  also  received  a  part  of  the  olivary  tract.  It  lies  in  the 
form  of  a  thick  bundle  outside  the  last  remnants  of  the  posterior 
cofumns. 

We  have  now  reached  the  level  at  which  we  get  a  typical 
section  of  the  medulla  oblongata.  Let  us,  now  that  we  have 
met  with  the  majority  of  the  structures  there  present,  take  a 
general  view  of  the  section  as  a  whole.  (See  Fig.  120.)  Many 
points  that  are  new  can  easily  be  added. 

In  the  ventral  portion  lie  the  pyramids.  The  large,  tri- 
angular field  of  dense,  transversely-divided  fibres  just  back  of 
them  is  the  inter-olivary  layer, — the  crossed  prolongation  of  the 
posterior-root  fibres.  The  nuclei  of  the  posterior -columns  lie 
externally  near  the  dorsal  surface,  still  covered  by  a  few  nerve- 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   199 

fibres.  Numerous  internal  arciform  fibres  take  their  origin  here, 
and,  passing  through  the  motor  area  of  the  tegmentum  (as  the. 
space  between  the  posterior  horn  and  the  inter-olivary  layer  is 
called),  enter  the  raphe  and  cross  to  the  opposite  side. 

The  fibres  of  the  cerebello-olivary  tract  follow  an  exactly 
similar  course  for  a  certain  distance.  In  the  figure  they  are 
represented  by  dotted  lines,  but  in  reality  the  two  kinds  of  in- 
ternal arciform  fibres  cannot  be  distinguished  in  the  adult. 


Fig.  n9. 

The  cerebello-olivary  portion  of  the  restiform  body.  The  fibres  terminate  mostly  in 
the  fleece  of  the  corpus  dentatum.  That  part  of  the  restiform  body  which  is  left  white 
indicates  the  situation  of  the  spinal-cord  portion. 

In  the  median  line,  of  course,  all  these  fibres  decussate 
with  those  coming  from  the  opposite  side.  This  line,  with  its 
numerous  decussations,  is  called  the  raplie. 

The  inter-olivary  layer,  or  layer  of  the  fillet,  contains  at 
this  level,  besides  the  tracts  which  ascended  in  tlie  antero-lateral 
column,  the  greater  part  of  those  originating  in  the  nuclei  of 
the  posterior  columns. 

Notice,  also,  the  fibres  passing  from  the  layer  of  the  fiUet 
to  the  nucleus  of  the  vagus  of  the  opposite  side.     They  are  the 


200 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


analogue  of  the  decussating  fibres  from  the  antero-lateral  columns 
to  the  posterior  horn, — the  central  vagus-tract. 

Dorsad  of  the  lemniscus  we  again  meet  with  the  posterior 
longitudinal  fasciculus,  which  was  described  in  the  seventh  lec- 
ture. Its  fibres  are  met  with  deep  in  the  anterior  column,  as 
low  down  as  the  first  cervical  nerve. 


Fin.  120. 
Section  through  the  medulla  oblongata. 

^Aufsteigende  Vagus  etc.   W.,  Ascending  vagus.  Bint.  Neh.  Olive,  Posterior  accessory  olivary 
etc  ,  root.  process. 

Aufst.  Trigem.    Würz.,  Ascending  root  of  tri-  Innere  Neb.  Olive,  Internal  accessory  olivary 

geminus.  process. 

Centr.  Haub.  Bahn,  Central  tegmental  tract.  Oliv.  Ztcisrh.  Schicht,  Inter-olivary  layer. 

Bint.  Liingsb.,  Popt.  longitud.  fasciculus.  Seit.  Str.  B.,  Lateral  cerebellar  tract. 
Vord.  Vag.  etc.  W.,  Anterior  vagus,  etc.,  root. 

The  lower  olivary  bodies  lie  on  both  sides,  external  to  the 
pyramids.  They  are  traversed  by  the  arciform  fibres.  Those 
arciform  fibres  which  come  from  the  cerebellum  terminate  here, 
while  those  originating  in  the  nuclei  of  the  posterior  columns 
are  merely  in  transit. 

Internal  to  and  dorsad  of  the  olivary  bodies  lie  the  internal 
and  posterior  accessory  olivary  bodies.     These  are  nuclei  whose 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   201 

structure  resembles  that  of  the  oHvary  bodies,  and  which,  hke 
them,  are  traversed  by  the  arciform  fibres.  As  is  shown  in  the 
ügure,  the  internal  accessory  olivary  body  is  traversed  principally 
by  the  fibres  passing  from  one  olivary  body  to  another,  while 
the  posterior  body  of  that  name  gives  passage  mainly  to  the 
fibres  of  the  posterior  columns.  The  internal  accessory  olivary 
nucleus  is  also  called  the  nucleus  pyramidalis. 

Dorsad  of  tlie  olivary  body,  in  the  vicinity  of  the  posterior 
accessory  olivary  nucleus,  is  a  medullary  tract,  which  w^e  shall 
see  from  now  on  occupying  a  position  in  the  midst  of  the  teg- 
mentum, and  which  can  be  traced  to  a  certainty  above  the 
origin  of  the  trigeminus.  Taken  together,  these  fibres — the 
central  tegmental  tract — probably  connect  the  olivary  body  with 
the  mid-brain. 

The  nerve-nuclei  are  situated  along  the  dorsal  periphery  of 
the  section. 

Next  to  the  median  line  is  the  nucleus  of  the  hypoglossal 
nerve,  whose  fibres,  after  passing  through  the  vicinity  of  the 
olivary  body,  run  ven trad.  (See  Fig.  116.)  It  receives  numerous 
fibres  from  the  raphe.  External  to  this  comes  the  common 
sensory  nucleus  of  the  accessory,  the  vagus,  and  the  glosso- 
pharyngeal nerve.  As  a  rule,  the  fibres  of  the  accessory  do  not 
issue  from  the  nucleus  at  tliis  level.  The  majority  of  tliem  arise 
lower  down  from  the  accessory  nucleus  proper,  which  is  situated 
in  the  upward  prolongation  of  the  lateral  horns.  A  remnant  of 
this  nucleus,  the  anterior  or  motor  nucleus  of  the  vagus  and 
glosso-pharyngeal,  lies  just  in  front  of  the  posterior  horn.  Its 
fibres,  before  emerging,  bend  at  an  angle  to  join  those  from  the 
sensory  nucleus. 

Tlie  thin  bundle  of  transversely-divided  fibres  lying  exter- 
nal to  th(;  last-named  nucleus  is  the  common  ascending  root  of 
tlie  vagus  and  gl|)sso-pl laryngeal.  External  to  the  common 
nucleus  of  these  nerves  lie  the  nuclei  of  the  posterior  columns, 
covered  over  by  a  few  fibres.  Ventrad  of  them  you  can  see  the 
substantia  gelatinosa  of  the  head  of  tin;  posterior  horn  of  the 


202  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

spinal  cord.  Externally  this  is  covered  by  a  bundle  of  fibres, 
which  is  separated  into  numerous  fasciculi,  and  which  has  ac- 
companied it  from  the  upper  cervical  cord.  This  bundle  has 
become  somewhat  larger  near  its  upper  extremity,  and  can  be 
traced  high  up  into  the  pons.  There  it  associates  itself  with 
the  emerging  fibres  of  the  trigeminus,  and  perhaps,  too,  enters 
into-some  relation  with  their  nucleus.  This  bundle,  the  ascend- 
ing root  of  the  trigeminus,  has  been  described  before  (Fig.  109) 

The  region  between  the  olivary  bodies  and  the  nuclei  of 
the  posterior  columns,  bounded  externally  by  the  direct  lateral 
cerebellar  tract  and  the  ascending  root  of  the  fifth  nerve  and 
internally  by  the  lemniscus,  contains,  besides  the  numerous  inter- 
nal arciform  fibres,  a  great  number  of  short  fibres  whose  course 
can  be  traced  but  a  short  distance.  Scattered  throughout  them 
are  numerous  multipolar  ganglion-cells.  We  call  this  function- 
ally unknown  formation  the  formatio  reticularis,  and  the  space 
occupied  by  it  the  motor  area  of  the  tegmentum.  Masses  of 
cells  are  found  in  this  situation  in  all  vertebrates.  They  can  be 
traced  as  scattered  groups  of  cells  up  to  the  line  of  the  ra-plie. 
As  long  as  we  possess  no  information  concerning  them,  we  shall 
do  well  to  adopt  the  name  given  them  by  Bechterew, — nucleus 
reticularis  tegmenti. 

The  fibres  of  the  ailtero-lateral  columns,  which  do  not 
enter  the  layer  of  the  fillet,  can  be  traced  into  the  formatio 
reticularis.     It  is  possible,  however,  that  they  pass  higher  up. 

On  making  farther  sections  through  the  oblongata  the 
picture  changes  but  little  for  about  two  millimetres.  We  see 
the  sensory  nucleus  of  the  vagus  and  glosso-pharyngeal  project- 
ing far  upward,  and  continually  sending  ofi"  root-fibres  toward 
the  periphery  from  its  own  ventral  surface.  The  ascending  root 
also  gives  ofi"  an  occasional  rootlet  to  join  the  latter.  The 
greatest  change  is  in  the  restiform  body,  whi^h  increases  greatly 
in  size,  for  at  this  level  it  has  begun  to  receive  the  fibres  passing 
from  the  cerebellum  to  the  olivary  body. 

The  sections  made  just  before  reaching  the  pons  show  (Fig. 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   203 

121)  that  the  nuclei  of  the  posterior  columns  have  almost  dis- 
appeared, tlie  hypoglossal  nucleus  lying  extended  over  a  wide 
area,  and  the  huge  fibrous  mass  of  the  restiform  body  occupying 
a  great  amount  of  space. 

Internal  to  the  latter  appears  the  section  of  a  new  bundle 
of  fibres, — the  direct  sensory  cerebellar  tract.  It  is  difficult  to 
say  just  where  it  commenced;    possibly  as  low  down  as   the 


Fig.  121. 
The  structure  of  the  medulla  oblongata  at  the  caudal  border  of  the  pons. 

Cenir.  II.  B.,  Central  tegmental  tract.  Dir.  Seitx.  Cereh.  B.,  Direct  sensory  cerebellar  tract. 

posterior  columns.  It  may  be  that  this  area  of  transversely 
divided  fibres  also  contains  an  ascending  root  to  the  acoustic 
nerve.  Fibres  run  from  the  restiform  body  to  the  inferior 
olivary  body,  which  latter  at  this  level  is  very  much  diminished 
in  size.  Both  the  fillet  and  the  central  tegmental  tract  appear 
just  as  they  did  in  the  last  section  examined.  Two  new  nuclei 
liave  appeared, — one,  situated  in  the  locality  from  whicli,  in 
section»-  farther  down,  the  fibres  of  the  motor  vagus  arose  CFig. 


204 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


132),  sends  all  its  fibrils  dorsad  and  toward  the  middle  line,  near 
which  they  are  gathered  into  a  small  bundle.  This  is  the 
nucleus  of  the  facial  nerve.  The  second  of  the  new  nuclei  lies 
external  to  the  restiform  body.  In  this  section  we  only  see 
fibres  passing  to  it  from,  the  dorsal  nucleus  of  the  acoustic, 
which,  at  this  level,  is  just  beginning  to  appear.     But  in  making 


\  v*V    V  '7// ''  //yC^ 


^Ouoai^S^ 


Fig.  122. 
The  most  important  structures  shown  by  a  section  through  the  vicinity  of  the  origin  of 

the  acoustic  nerve. 

Cent.  H.  B.,  Central  tegmental  tract. 

the  next  sections  you  will  see  that  we  are  dealing  with  a  large 
structure,  the  ventral — formerly  the  anterior — nucleus  of  the 
acoustic  nerve.  You  will  observe  even  here  how  it  is  wedged 
in  between  the  cerebellum  and  the  restiform  body.  The  enlarge- 
ment ventrad  of  this  nucleus  on  the  outer  surface  of  the  oblongata 
is  called  the  tuberculum  acusticum. 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   205 


In  our  upward  progress  we  have  now  reached  the  point 
where  the  lowest  fibres  of  the  pons,  running  across  the  pyramids 
from  the  cerebellum,  appear  at  the  ventral  periphery  of  the 
section. 

Here  we  strike  a  region  where  several  important  structures 
are  compressed  into  a  relatively  small  space,  the  region  of  the 
origin  of  the  acoustic,  the  facial,  and  the  abducens  nerves. 

In  the  section  represented  in  Fig.  122  you  see  that  from 
the  ventral  nucleus  of  the  acoustic  there  arises  a  root  composed 
of  fine  fibres.  This  is  the  radix  posterior  acustici.  You  will 
also  notice  that  another  tract  ruils  upward  from  this  same  nucleus 
and  in  part  enters  a  rounded  nucleus,  the  superior  olivary  body, 


J^,ab<Ji 


uceus 

Fig.  124. 


^/iUä/Üj 


Fig.  123. 

Medulla  oblongata  and  pons  of  an  ape.  Diagram  of  the  central  course  of  the 

To  show  the  corpus  trapezoides.  facial  and  abducens  nerves. 

Knie,  Knee. 

and  in  part  extends  over  the  median  line.  These  latter  fibres 
pass  transversely  through  the  layer  of  the  fillet,  w4iich  is  placed 
in  the  dorsal  portion  of  the  pons.  In  the  lower  animals,  where 
the  pons  is  much  sliorter  than  in  human  behigs,  this  tract  can 
be  seen  as  a  quadrangular  medullary  area  passing  across  the 
pyramids  in  the  ventral  portion  of  the  oblongata.  This  area 
and  the  fibres  it  contains  have  received  the  name  of  corpus 
trapczoides. 

The  fibres  in  the  corpus  trapezoides  connect  the  ventral 
acoustic  nucleus  with  the  superior  olivary  body  of  the  same  and 
of  the  opposite  side.  This  is  made  clear  in  the  following  cut 
(Fig.  125). 


206 


LECTURES   ON    THE   CENTRAL   NERVOUS   SYSTEM. 


Internal  to  the  restiform  body,  which  at  this  level  begins 
to  incline  toward  the  cerebellum,  lies  the  dorsal  acoustic  nucleus, 
which,  just  here,  has  reached  its  greatest  expansion.  The  fibres 
of  the  direct  sensory  cerebellar  tract  pass  through  it,  and  a  few 
of  them  pass  into  the  acoustic  nerve.  From  its  ventral  border 
emerges  the  anterior  acoustic  root,  which  is  composed  of  coarse 


Fig.  125. 

Section  in  the  vicinity  of  the  origin  of  the  abducens  nerve. 

Cent.  H.  B.,  Central  tegmental  tract. 

fibres.  This  nucleus  is  also  connected  with  the  upper  olivary 
body.  It  is  possible,  however,  that  these  latter  fibres  do  not 
originate  in  the  nucleus  itself,  but  merely  pass  through  it  on 
their  way  from  the  cerebellum^.  In  cats  a  connection  between 
the  superior  olivary  body  and  the  cerebellum  is  easily  shown. 
In  adult  human  beings  "we  see  numerous  thick  fibres  arising 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   207 

from  the  raphe  ;  these  pass  upward,  and  decussate  very  near  the 
Üoor  of  the  rhomboidal  fossa.  They  are  here  gathered  into 
bundles,  which  run  across  this  floor.  These,  the  striae  acusticae, 
which  pursue  a  course  analogous  to  that  of  the  central  sensory 
tract,  pass  from  above  downward  into  the  dorsal  nucleus;  then, 
skirting  along  the  border  of  the  restiform  body,  are  continued  on 
to  the  ventral  nucleus  of  the  acoustic  nerve  (Figs.  121  and 
122). 

Monakow  states  that  these  striae  atrophied  after  he'  had 
divided  the  opposite  lemniscus  high  up  near  the  corpora  quad- 
rigemina.  This,  and  their  situation  in  the  lower  animals,  lead 
to  the  conclusion  that  they  are  the  central  sensory  tract  of  the 
acoustic. 

At  this  level  no  new  nucleus  has  appeared,  only  that  of  the 
facial  nerve  has  increased  in  size.  Fibres  from  the  a.scending 
root  of  the  trigeminus  are  given  off  to  the  root  of  the  last-named 
nerve.  This  is  important,  for  we  know  that  from  just  this  por- 
tion of  the  trigeminus  come  the  sensory  fibres  of  the  face. 

Somewhat  farther  forward  (Fig.  125)  the  fibres  of  the  facial 
have  been  gathered  together  into  a  nerve-trunk.  This,  however, 
does  not  pass  at  once  to  the  surface,  but  runs  cephalad  for  a 
short  distance,  and  then  turns  in  the  direction  of  the  basis.  In 
tliis  way  it  makes  two  turns, — one  in  the  horizontal  and  one  in 
the  descending  part  of  its  course.  Just  in  the  bend  between 
these  two  turns  is  situated  the  nucleus  of  the  abducens  (Fig.  124). 

The  root-fibres  of  the  abducens,  gathered  into  several 
bundles,  run  a  straight  course  tlirough  the  tegmentum  and  ])ons, 
and  emerge  laterally  on  the  ventral  surface  of  the  latter.  The 
nucleus  is  connected  internally  with  the  posterior  longitudinal 
fasciculus.  It  has  been  stated,  but  I  think  without  sufficient 
foundation,  that  these  fibres  enter  the  opposite  oculo-motor 
nucleus  liigher  up.  On  the  other  hand,  there  is  certainly  a 
remarkable  connection  between  the  nucleus  of  the  abducens  and 
tlie  superior  olivary  body.  This  tract,  which  you  see  ruiuiing 
parallel  to  tlie  root  of  the  facial  nerve  in  Fig.  125,  must  connect 


208  LECTURES    ON    THE    CENTRAL    NERYOUS    SYSTEM. 

the  acoustic  nerve  with -the  nerves  governing  the  movements  of 
the  eye.  It  may  be  of  importance  in  connection  with  our  judg- 
ment of  space  measurements. 

External  to  the  dorsal  acoustic  nucleus,  imbedded  in  the 
direct  sensory  cerebellar  tract,  lies  a  nucleus  whose  significance 
is  wholly  unknown.  It  Avas  formerly  called  the  external  acoustic 
nucleus.  It  atrophies  if  the  cervical  cord  is  divided  on  the 
same  side  (Monakow).  No  connection  between  it  and  the  nerves 
of  hearing  has  been  clearly  shown.  It  is,  therefore,  better  for 
the  present  to  call  it  Deiters'  nucleus,  in  honor  of  that  great 
investigator  of  the  medulla  oblongata. 

The  method  of  origin  of  the  acoustic  nerve,  which  was 
long  in  doubt,  has  been  the  subject  of  study  by  a  number  of 
investigators.  The  results  obtained  by  some  do  not  agree  with 
the  statements  which  have  been  made  here,  and  which  are  based 
on  personal  research. 

The  author  and  Freund,  whose  investigations  were  con- 
ducted upon  human  embryos,  have  arrived  at  practically  the 
same  conclusions.  Bechterew  and  Flechsig  contend  that  the 
anterior  root  does  not  arise  from  the  dorsal  nucleus,  but  rather 
from  some  cells  situated  in  the  vicinity  of  Deiters'  nucleus.  The 
origin  of  the  posterior  roots  from  the  ventral  nucleus  is  conceded 
by  all.  Tearing  out  the  acoustic  nerve  results  in  atrophy  of 
this  nucleus  (Forel,  Onufrowics,  Baginski). 

Let  us,  before  we  go  farther,  again  look  up  the  structures 
of  the  tegmentum  which  have  not  been  specially  mentioned  in 
the  text,  and  ascertain  their  situation  and  fOrm  at  these  levels. 
One,  tlie- nucleus  reticularis  tegment.i,  which,  together  with  the 
fibres  of  the  substantia  reticularis,  is  spread  out  over  the  area 
between  the  raphe  and  the  root  of  the  facial  nerve,  has,  for  the 
sake  of  clearness,  been  omitted  from  the  illustrations.  We 
could  have  seen  it  in  all  the  sections  through  the  levels  which 
we  have  been  studying. 

The  following  figure  (Fig.  126)  represents  the  section  lying- 
just  ahead  of  the  preceding  one,  and  is  only  given  to  show  how 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   209 

the  facial  nerve  curves  backward,  and  the  entrance  of  the  direct 
sensory  cerebellar  tract  into  the  cerebellum.  In  sections  made 
at  this  level  tlie  anterior  cerebellar  peduncles  begin  to  appear. 

After  the  facial,  the  acoustic,  and  the  abduccns  have  left  the 
tegmentum,  its  conformation  naturally  becomes  much  simpler. 

We  are  approaching  the  source  of  the  trigeminus.  First. 
in  the  prolongation  of  the  nucleus  of  the  facial,  but  somewhat 
more  dorsad,  appears  the  motor  nucleus  of  the  trigeminus.  From 
it  arises  the  motor  root,  the  portio  minor,  which  also  takes  a 


Fig.  126. 
Section  at  the  point  where  the  internal  division  of  the  restiform  body  enters  the  cerebellum. 

Bindearm,  Sup.  cerebellar  peduncle.     Dir.  Senji.  Cer.  B.,  Direct  sensory  cerebellar  tract. 

slightly-curved  course.  This  root  supplies  the  muscles  of  masti- 
cation. Probably  this  root  also  contains  fibres  from  the  opposite 
motor  nucleus  which  have  crossed  in  the  raphe. 

Other  fibres  leave  the  pons,  together  witli  the  trigeminus. 
w}iic;li  do  not  arise  in  the  motor  nucleus,  but  high  up  in  the 
fpiadrigeminal  region,  wliere  a  few  cells  at  the  side  of  the  aque- 
duct giv(;  off  this  descending  root  of  the  fifth  nerve.  (See 
Fig.  72,  above  and  to  tlie  left.) 

These  cells  are  continued  caudad  in  the  lateral  walls,  and 
we  can  see  a  larire  collection  of  them  shininj'  tliroui^h   tlie  thin 


210  LECTURES   ON   THE   CENTRAL   NERVOUS    SYSTEM. 

ependyma  of  the  ventricle,  forming  a  dark  group  of  cells  on 
either  side,  and  at  the  anterior  extremity  of  the  fourth  ventricle. 
This  area  is  called  the  locus  coeruleus. 

The  main  part  of  the  trigeminus,  the  sensory  portion,  gets 
but  very  few  fibres  from  the  pons.  They  come  rather  from  all 
levels  above  the  cervical  spinal  cord  up  to  its  point  of  emergence 
from  the  brain.  It  has  often  been  mentioned  before,  and  is  the 
thick,  crescentic  bundle  of  medullary  fibres  which  surrounds  the 
head  of  the  posterior  horn  in  almost  all  the  illustrations  shown 
in  the  last  two  lectures.  Near  the  motor  nucleus  this  main 
trunk  dips  forward  into  the  pons,  and  emerges  from  it  as  the 
portio  major,     (See  Fig.  113.) 

Fibres  also  come  from  the  dorsal  region  to  enter  the  portio 
major.  They  are  fasciculi  from  the  direct  sensory  cerebellar 
tract.  There  are  not  many  of  them.  In  lower  animals,  how- 
ever, particularly  in  fishes,  they  constitute  the  greater  part  of. 
the  nerve-root,  and  their  point  of  origin  in  the  cerebellum  is  so 
largely  developed  as  really  to  form  one  of  the  lobes  of  that  body. 

Lastly,  there  is  an  enlargement  of  the  substantia  gelatinosa 
at  its  cerebral  termination,  which  is  regarded  as  a  sensory 
nucleus  of  the  trigeminus.  It  receives  masses  of  fibres  which 
run  to  it  from  the  raphe  across  the  floor  of  the  rhomboidal  fossa. 
Similar  fibres  also  pass  to  the  locus  cceruleus.  They  represent 
the  central  tract  which  we  have  discovered  as  belonging  to  all 
the  cranial  nerves.  Comparative  embryology  teaches  us  that 
this  considerable  bundle  of  fibres  comes  from  the  opposite  fillet, 
and  that  after  leaving  it  they  run  a  short  distance  horizontally 
through  the  substantia  reticularis. 

The  trigeminus  roots  cannot  be  shown  in  a  single  section. 
They  come  from  dorsal  and  ventral  areas  to  their  junction  on 
the  floor  of  the  rhomboidal  fossa,  where  they  turn  and  pass 
downward  to  their  exit. 

From  the  level  of  exit  of  the  fifth  nerve  up  to  the  level 
where  the  trochlear  nerve  emerges,  the  tegmentum  has  a  much 
simpler  structure  than  we  have  previously  made  out. 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   211 


In  the  section  which  I  last  showed  you  the  anterior 
peduncles  had  begun  to  separate  themselves  from  the  mass  of 
the  cerebellum.  They  now  leave  it  altogether  and  are  found 
externally  on  each  side  of  the  tegmentum.  The  layer  of  the 
fillet  is  a  broad  structure  which  here  in  the  pons  separates  the 


Fio.  127. 
Section  at  the  point  where  the  ascendinj^  root  of  the  trigeminus  bends  outward.    Roots 

of  trigeminus. 

Cenlr.  It.  lt..  Central  tegmuntal  tract.  Vi-nlr.  V.  Hiilin,  Central  tract  of  fiftli  nerve. 

Dir.  Senn.  Ci-rrhi-Uiirhahn,  Direct  »ensury  cerebellar  tract. 

fibres  of  tlic  tegmentum  from  those  of  the  crusta,  just  as  it  did 
in  .sections  made  fartlier  forward  tlirough  the  crura  cerebri. 

We  can  distinguish  in  the  fillet  an  outer  lateral  portion 
and  a  more  median  one.  Tlie  former  is  already  beginning  to 
trend  upward  to  the  quadrigeminal  region,  and  the  latter  will 
follow  its  example  a  little   farther  forward.     Just  at  tlie  point 


212 


LECTURES    ON    THE    CENTRAL   NERVOUS    SYSTEM. 


where  the  fillet  begins  to  turn  upward  there  are  found  some 
ganglion-cells  imbedded  in  it  (lateral  nucleus  of  the  lemniscus^ 
Obersteiner).  This  group  can  be  traced  upward  to  the  upper 
nucleus  of  the  fillet,  which  is  situated  on  the  outer  border  of  the 
substantia  nigra.  Those  fibres  of  the  fillet  which  lie  nearest  the 
ra}DM  form  a  separate  bundle.  This  arises  from  the  pyramidal 
portion  of  the  crusta.  It  was  shown  in  the  seventh  lecture  how 
this  bundle  became  separated  from  the  pes,  passing  around  its 


Fig.  128. 
Section  through  the  upper  pontine  region  of  a  foetus  in  the  ninth  month. 

Bindearm,  Anterior  cerebellar  peduncle.     Brücke,  Pons.     Schleife,  Fillet. 

whole  internal  border  and  extending  to  the  median  side  of  the 
fillet.  Spitzka's  studies  in  comparative  anatomy  have  made  it 
very  probable  that  this  little  bundle  contains  the  central  tracts 
of  the  motor  cranial  nerves.  We  may  easily  ascertain  that 
fibres  are  continually  given  off  from  it  which  ascend  in  the 
rapM^  and  can  see  that,  at  the  upper  end  of  the  raphe^  fibres 
pass  over  beyond  the  middle  line  to  the  nerve-nuclei.  This  is 
shown  most  clearly  with  reference  to  the  hypoglossal  nerve. 


THE  MEDULLA  OBLONGATA  AND  TEGMENTUM  OF  THE  PONS.   'il3 

We  are  now  gradually  approacliing  that  region  of  the  pons 
where  tlie  roof  of  the  hmd-hram  is  no  longer  formed  l)y  tlie 
cerehellum,  hut  hy  the  velum  medulläre  antioum.  The  fourth 
ventricle  here  begins  to  narrow  down  to  form  the  aqueduct  of 
Syhius. 

The  different  structures  which  constitute  the  tegmentmn  nt 
this  level  are  very  clearly  shown  in  the  accompanying  non- 
diagrammatic  section  through  the  upper  part  of  the  pons  of  a 
9  months'  fcetus.  At  this  period  only  one  small  fasciculus  of 
the  pes  is  medullary.  In  the  tegmentum,  however,  the  layer  of 
the  fillet,  the  anterior  cerebellar  peduncles,  the  posterior  longi- 
tudinal fasciculus,  and  many  of  the  fibres  of  the  substantia 
reticularis  are  fully  developed.  The  anterior  peduncles  are 
continuous  above  with  the  velum  medulläre  anticum,  upon  which 
rests  the  anterior  extremity  of  the  lingula.  Lower  down,  just 
above  the  fillet,  can  be  seen  the  most  posterior  of  the  decussating 
fibres  of  the  anterior  cerebellar  peduncles,^  The  descending  root 
of  the  trigeminus  lies,  a  thin  bundle  of  fibres,  on  each  side  of 
the  aqueduct.  You  must  imagine  the  cells  of  the  locus  coeru- 
leus  placed  just  under  the  floor  of  the  aqueduct  or  the  rhom- 
boidal fossa.  They  did  not  show  well  in  this  specimen.  The 
reticular  substance  here  consists  mostly  of  longitudinal  fibres,. 
which  cannot  be  traced  higher  than  the  level  of  the  anterior 
quadrigeminal  bodies.  Near  the  middle  line  on  each  side  is  the 
posterior  longitudinal  fasciculus. 

From  this  \v.\v\  up  to  the  quadrigeminal  region  the  appear- 
ance of  tire  tegmentum  does  not  materially  change.  The  fillet 
begins  to  work  its  way  externally  and  dorsad  of  the  tegmentum 
to  reach  the  region  under  the  corpora  quadrigemina.  You 
remember  tliat  these  ascending  fibres  of  the  fillet  could  be  seen 
even  in  sections  througli  the  mid-brain.  The  anterior  peduncles 
approach  each  other  and  at  last  decussate  higlier  up. 

You  have  already  observed  the  fibres  of  the  crusta  and  the 
fasciculi  of  tlie  pons  penetrating  them.  It  should  be  added  tliat 
in   the  anterior  levels  of  the  pons  there  is  a  system  oi'  fibres 


214  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

which  become  medullary  shortly  before  birth,  and  which  passes 
out  of  the  pons,  ascends  in  the  raphe,  and  sends  its  fibres  right 
and  left  into  the  reticular  substance  of  the  tegmentum.  Accord- 
ing to  Bechterew  they  terminate  in  the  most  anterior  part  of  the 
reticular  nucleus. 

Ganglion-cells  possessing  a  structure  similar  to  those  of  the 
pons  can  be  found  scattered  along  on  both  sides  of  the  raphe^ 
and  can  be  traced  also  in  that  structure  into  the  tegmentum. 


LECTURE   XII. 


THE    PONS FINAL    REVIEW. 


Gentlemen  :  We  reached,  in  our  last  lecture,  that  level  of 
the  tegmentum  which  we  discussed  in  the  eighth  lecture.  A 
few  millimetres  cephalad  of  the  last  section,  the  fibres  of  the 
pes  emerge  from  under  the  pons  to  pass  independently  to  the 
brain.  In  the  medulla  oblongata  the  pyramids  are  the  only 
structures  which  pass  into  the  pes ;  but  from  the  ganglia  of  the 
pons  huge  bundles  of  fibres  emerge,  which  run  in  the  median 
and  lateral  portions  of  the  crusta,  and  can  be  traced  as  far  as 
the  cortex  of  the  frontal,  parietal,  and  temporal  lobes. 

Now,  again,  we  see  the  substantia  nigra  dividing  the  pes 
from  the  tegmentum. 

The  anterior  cerebellar  peduncles  are  lost  in  the  red  nuclei, 
and  in  place  of  the  velum  medullary  anticum  the  roof  is  formed 
by  the  corpora  quadrigemina. 

The  reproduction  of  a  few  sections  which  have  been  given 
before  may  recall  to  mind  what  was  then  said,  and  make  clear 
the  transition  from  the  pons  into  the  quadrigeminal  region. 
(See  Figs.  129,  130,  and  131.) 

The  symptoms  which  arise  in  diseases  of  the  pons  and  ob- 
longata are,  from  the  manner  in  which  they  are  grouped,  a 
pretty  good  proof  of  the  correctness  of  our  views  of  the 
anatomical  relations  of  these  parts. 

Tracts  are  here  crowded  into  a  small  space,  which  are  of  the  utmost  impor- 
tance in  movements  of  the  muscles,  in  sensation,  speaking,  swallowing,  etc.  A 
disease  focus  need  he  but  small  to  cause  many  diffeient  symptoms  here. 

The  central  motor  and  sensory  tracts,  which  arise  from  the  cortex  as  well  as 
from  the  inter-  and  inid-  brains,  pass  through  the  pons  and  oblongata,  and  only 
give  off  tliose  fibres  which  go  to  the  nuclei  of  the  cranial  nerves. 

Inasmuch  as  a  break  in  the  conductivity  of  these  long  tracts  will  cause  the 
same  symptoms,  whellurr  it  occur  in  the  fore-,  mid-,  or  hind-  brains,  we  can  only 
suspect  disease  of  the  pons  or  oblongata  if  symptoms  are  at  tlie  same  time  present 
which  show  that  one  or  move  of  the  cranial-nerve  nuclei  have  becui  inv(jlved. 

(215) 


216 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


The  musculai-  atrophy  which  follows  affections  of  the  nuclei  themselves 
(see  Fig.  68  and  accompanying  text)  must  be  studied  with  scrupulous  care  if  we 
are  to  succeed  in  discovering  the  location  and  extent  of  such  a  disease.  Fig.  133, 
which  gives  j'^ou  a  general  view  of  the  nuclei  in  a  longitudinal  section  through 
the  oblongata,  will  make  this  task  somewhat  easier  for  you  than  it  was  possible  for 
the  transverse  sections  through  the  nuclei  to  do. 

Disturbances  of  speech,  respiration,  or  deglutition  probably  depend  on 
disease  of  the  oblongata, — paralysis  of  muscles  of  mastication  (motor  portion  of 
trigeminus),  facial  paralysis,  or  affections  of  the  abducens  on  disease  of  the  pons. 
Inasmuch,  however,  as  the  central  fibres  to  the  nerve-nuclei  of  the  oblongata 
pass  through  the  pons,  a  disease  situated  there  may  also  cause  disturbances  of 
deglutition. 

The  motor  tracts  to  the  extremities  lie  anteriorly  near  the  ventral  border  in 
the  pyramids.  They  only  cross  to  the  opposite  side  far  down  near  the  beginning 
of  the  spinal  cord.     The  motor  fibres  of  the  cranial  nerves,  on  the  other  hand,  lie 


Fig.  129. 


Fig.  130. 


Fig.  131. 


Three  sections  through  the  pons  and  quadriweminal  region  of  newborn  children, 
to  show  the  course  of  the  cerebeUar  peduncles  and  the  layer  of  the  fillet.  The  latter  is 
situated  just  above  the  fibres  of  the  pons.  The  cerebellar  peduncles,  B  (Fig.  129),  are 
situated  more  internally  in  Fig.  130,  and  are  beginning  the  decussation,  which  is  at  its 
height  in  Fig.  131.     (Hsematoxylin  stain.)  :' 

near  the  middle  line.  They  ascend  in  the  raphe  of  the  tegmentum,  and  only  cross 
to  the  opposite  side  just  before  reaching  the  nucleus  to  which  they  are  tending. 
A  disease  in  the  pons,  therefore,  will  generally  involve  the  opposite  extremities, 
but  will  affect  the  facial  abducens  or  trigeminus  of  its  own  side.  The  diagram 
(Fig.  133)  is  intended  to  impress  upon  your  memory  more  forcibly  than  can  be  done 
by  written  desci'iptions  this  crossed  paralysis,  which  is  the  most  important  symp- 
tom in  many  affections  of  the  pons  and  medulla.  It  represents  the  motor  inner- 
vation-tract  for  the  face  and  extremities.  You  see  from  the  cut  that  a  lesion  at  A, 
in  the  right  side  of  the  cerebrum  or  right  crus,  would  paralyze  the  left  facial  nerve 
and  the  left  extremities.  A  disease  at  B,  on  the  right,  in  the  vicinity  of  the  pons, 
would  still  paralyze  the  left  extremities  but  the  right  facial.  Should  such  a  disease 
extend  beyond  the  middle  line  it  might  paralyze  both  facial  nerves  and  the  extremi- 
ties on  one  side.  You  see,  also,  in  the  diagram,  that  a  disease  in  the  pons  (at  C) 
might  be  so  situated  as  to  give  rise  to  unilateral,  not  alternating,  hemiplegia, — that 
is,  it  may  cause  the  same  symptoms  as  thougli  it  were  situated  in  the  cerebrum. 
Alternating  paralysis  can  only  (except  in  cases  of  multiple  foci)  be  caused  by  dis- 


THE   PONS FINAL    REVIEW. 


217 


ease  of  the  pons,  or  tumors,  etc.,  located  in  front  of  the  pons,  which  impinge  upon 
the  peripheral  portion  of  the  cranial  nerves  and  upon  the  pyramids.  Inas- 
much as  the  nuclei  of  the  abducens  and  trigeminus  are  also  located  in  the  pons, 
these  nerves  may  cause  manifold  modifications  in  the  sj'mptom-complex  present 
in  cases  of  alternating  paralysis  originating  in  disease  of  that  part.  How  the 
acoustic  nerve  would  be  aft'ected  in  such  a  case  is  still  uncertain. 

Through  the  pons,  also,  pass  all  the  fibres  to  the  nerve-nuclei  of  tlie  ob- 
longata, which  supply  the  muscles  of  speech.  Thus,  in  diseases  of  the  pons  and 
oblongata,  we  see  disturbances  of'articulation,  in  spite  of  undiminished  power  of 
utterance.  We  call  this  either  dysarthria  or  anarthria,  according  to  the  degree  in 
which  it  is  present. 

D,iseases  of  the  pons  maj'  also  lead  to  sensory  disturbances.  If  it  is  located 
in  the  outer  region,  in  the  vicinity  of  the  fillet,  and  is  unilateral,  we  shall  have 
hemianiesthesia  of  the  opposite  side. 


Fig.  132. 

The  situation  of  the  cranial  nerves.    The  nieihiUa  oblongata  and  the  pons  represented 

as  transparent. 


Still,  the  sense  of  taste  (trigeminus)  and  that  of  hearing  are  almost  always 
unimpaired,  and  the  same  may  be  said  of  the  sense  of  sight.  It  is  usually  but 
little  injured  (paralysis  of  abducens,  etc.).  The  picture  pr(;sented  by  intra-pontine 
liemianssthesia,  therefore,  dirters  markedly  from  that  produced  by  disease  in  the 
cerebrum.  Bilateral  hemiana'sthesia  may  be  caused  by  a  disease  situated  in  the 
middle  line  (inter-olivary  layer).  The  occasional  appearance  of  partial,  direct, 
and  alternating  anaesthesias  of  the  face  is  explained  by  the  situation  of  the 
trigeminal  nucleus. 

Disturbances  of  mastication  auci  deglutition  may  be  observed  also,  because 
the  motor  nuclei  of  the  trigeminus,  the  glosso-pharyngeal,  and  the  hypoglossal 
may  easily  be  affected  by  the  same  disease. 

It  is  often  difficult  to  decide  whether  a  disease  is  seated  in  the  medulla  or 
the  pons.  P'roiii  the  sil nation  of  the  motor  nuclei  of  tlie  vagus,  accessory  and 
glo.sso-pharyngeal  nerves  sudi  symptoms  as  hoarseness,  loss  of  voice,  and  respir- 
atory disturbances  are  usually  only  observed  in  diseases  of  the  oblongata.  Dis- 
turbances of  articulation,  dysarthria,  and  anaithria  (nucleus  of  hypoglossal),  and 


218 


LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 


•  1 


Fig.  133. 

Diagram  of  the  motor  mnervation  tract  for  the  facial  nerve  and  the  nerves  to 
the  extremities.  Frontal  section  through  the  cerebrum,  the  pedunculi  cerebri,  the 
pons,  the  medulla  oblongata,  and  the  spinal  cord. 

Rinden-Centren/Ur  die:  Extremitäten— J iir  das  Gesicht,  Cortical  centres  for  the  extremities— 

for  the  face. 


THE    PONS FINAL    REVIEW.  219 

disturbances   of    circulation   are   also   more   often   caused   by   atfeclions   of   the 
oblongata.  • 

Almost  all  these  symptoms  may  be  caused  in  rare  cases  by  disease  in  the 
cerebrum,  inasmuch  as  injury  to  the  central  tracts  of  the  cranial-nerve  fibres  is 
t'ollowed  by  paralysis,  just  as  is  injury  to  the  nucleus  or  to  the  peripheral  nerve. 
Paralysis  of  certain  muscles  supplied  by  nerves  originating  in  the  oblongata  can 
only  be  ascribed  to  disease  of  the  latter  wlien  simultaneous  muscular  atrophy 
appears,  and  an  injury  to  the  trunk  of  the  nerve,  outside  the  central  organ,  can 
be  excluded. 

Gentlemen  :  Our  task  is  nearly  done.  A  great  number  of 
Important  systems  of  fibres  have  been  studit>d,  both  with  regard 
to  their  relations  to  the  central  gray  ganglia  and  to  their  course 
iVom  the  fore-brain  down  to  the  termination  of  the  mid-brain, 
or  from  the  spinal  cord  up  to  the  same  level.  Still,  it  seems 
advisable  again  to  examine  a  few  of  them  brieiiy,  either  because 
they  are  of  particular  importance  in  connection  with  physiology 
or  pathology,  or  because  the  comprehension  of  their  whole 
course  was  rendered  more  difficult  on  account  of  their  being 
traced,  for  didactic  reasons,  in  an  opj)Osite  direction  after  Lecture 
\U.  Let  this  short  recital  serve  as  your  guide  in  a  sort  of 
re\  iew,  which  you  can  easily  undertake  with  the  aid  of  the 
illustrations. 

1.  The  pyramidal  tract:  The  most  important  -tract  of 
notor  innervation  arises  from  the  upper  two-thirds  of  the  central 
••on volutions  and  the  paracentral  lobule,  and  runs  to  a  point 
l)ehiud  the  knee  of  the  internal  capsule.  From  there  it  passes 
into  the  pe>  peduncuh.  where  it  occupies  the  middle  third.  In 
the  pons  its  fibres  are  but  little  divided  by  the  transverse  hbres 
of  the  latter. 

After  (mierging  from  tlic  pons  its  fibres  lie  in  two  thick 
bundles  on  tlie  ventral  surlace  of  the  oblongata.  In  this  position 
tluy  pa>s  to  tlie  spinal  cord.  Here  the  great  mass  of  the  fibres 
cross  to  the  op))osite  lat(Mal  cohunns;  a  smaller  portion  (anterior 
])yramidal  tract)  remains  on  the  same  side.  Both  these  masses 
of  fibres  enter  into  relations  witli  the  cells  of  tlie  anterior  horns 
of  tlie  side  opposite  their  cortical  origin  in  the  brain.  From 
tliese  cells  tlie  motor  n^ots  arise.      Compare  Figs.  44,  47,  56,  62, 


220  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

72,  73,  96,  97,  98,  99,  100,  102,  103,  104,  108,  113,  lU,  115, 
120,  125,  and  127.) 

2.  The  central  tract  of  the  motor  cranial  nerves  is  only 
accurately  known  in  the  case  of  the  facial  and  hypoglossal. 
The  facial  tract  arises  in  the  vicinity  of  the  lower  third  of  the 
central  convolutions.  Apparently  this  supplies  the  lower  hranches 
only ;  the  cortical  centre  of  the  frontal  branches  is  not  known 
(gyrus  angularis'?).  It  then  passes  inward  across  the  lenticular 
nucleus,  and  is  finally  found  in  tlie  internal  capsule,  very  close 
to  the  pyramidal  tract.  It  cannot  he  (clinically)  distinguished 
from  the  latter.  Its  fibres  then  abandon  the  general  motor  in- 
nervation tract  apparently  in  company  with  the  "  bundle  from 
the  pes  to  the  tegmentum,"  which  has  been  frequently  men- 
tioned. They  certainly  are  separated  in  the  pons  (see  diagram. 
Fig.  68).  It  is  not  known  how  it  reaches  the  nucleus.  At  all 
events  it  reaches  the  opposite  liicial  nucleus,  which  lies  in  the 
caudal  part  of  the  pons.  From  this  the  nerve  is  given  off.  (See 
Figs.  47,  121,  122,  124,  125,  126,  and  132.) 

In  the  most  ventral  portion  of  the  anterior  central  convolu- 
tion is  apparently  situated  the  cortical  centre  of  the  hypoglossal 
nerve.  At  all  events  bundles  pass  from  this  region,  ventrad  of 
those  going  to  the  facial,  whose  destruction  is  followed  by 
bilateral  disturbances  of  the  hypoglossal.  On  its  way  from  the 
cortex  to  the  internal  capsule  it  passes  over  the  upper  edge  of 
the  lenticular  nucleus,  and  must  lie  very  near  the  speech- tract, 
just  outside  the  commencement  of  the  tail  of  the  nucleus 
caudatus.  In  one  case,  which  came  under  my  observation,  a 
diseased  spot  not  larger  than  a  5-cent  piece  broke  down  both 
tracts  at  this  point.  In  the  internal  capsule  the  hypoglossal 
tract  probably  lies  between  that  of  the  facial  and  that  of  the 
extremities.  Inside  the  pons  its  fibres  must  become  separated 
from  the  pyramids.  They  apparently  withdraw  from  the  latter 
on  the  median  side  of  the  fillet,  and  pass  upward  and  backward 
in  the  raj)he.  It  is  only  on  reaching  the  oblongata  that  they 
pass  to  the  nucleus  of  the  opposite  (and  the  one  on  the  same"?) 


THE    PONS FINAL    REVIEW.  '2'2l 

side.     From  these  nuclei  arise  the  nerve.     (Compare  Figs.  47, 
108,  110,  lU,  115,  116,  and  132.) 

3.  The  motor  speech-tract.  We  possess  certain  knowledge 
of  only  a  fen'  points  along  this  tract, — the  point  of  origin  in 
the  lower  frontal  convolution,  the  terminal  point  in  the  nuclei 
of  the  facial  and  hypoglossal,  and,  between  tlie  two,  a  point  out- 
side the  tail  of  the  nucleus  caudatus.  Apparently  (Wernicke) 
the  tract  passes  somewhat  toward  the  median  line  from  Broca's 
convolution — third  frontal — and  pursues  an  almost  horizontal 
course  under  the  island,  dorsad  of  the  internal  capsule.  Its 
fibres  then  pass  into  the  internal  capsule  behind  the  motor  tracts, 
and  from  there  run  to  the  crusta.  In  the  pons  they  must 
gradually  pass  up  into  the  tegmentum.  Disturbances  of  speech 
have  been  observed  in  disease  of  all  the  above-mentioned  points. 
(See  Figs.  27  and  28.) 

4.  The  coronal  fibres  to  the  pons  arise  from  the  cortex  of 
the  fore-brain,  particularly  from  the  frontal  and  parieto-occipital 
lobes.  They  pass  through  the  internal  capsule  into  the  crusta, 
and  from  there  into  the  pons  (Fig.  56).  From  here  they  pass 
either  directly  or  through  interpolated  ganglion-cells  into  the 
middle  peduncles  of  the  cerebellum,  or  brachia  pontis. 

5.  The  tegmental  radiation  arises  in  the  parietal  lobe,  pos- 
sibly in  the  same  regions  as  the  pyramidal  fibres,  and  passes  into 
the  posterior  third  of  the  internal  capsule.  In  this  situation  it 
is  very  closely  approached  by  the  optic  radiation  from  the  oc- 
cipital lobe,  and  by  the  central  tract  of  the  acoustic.  (As 
regards  the  latter  tract,  this  has  been  demonstrated  clinically, 
but  not  anatomically).  A  part  of  the  tegmental  tract  passes 
into  and  through  the  lenticular  nucleus,  and  a  part  passes 
directly  into  the  fillet.  Probably  these  two  portions  become 
united  on  the  median  side  of  the  body  of  Luy's, — upper  fillet. 
(Compare  Figs.  47,  51,  52,  54,  56,  and  59.) 

6.  The  largest  part  of  th(^  fillet  arises  from  the  deep  marrow 
oi"  the  corpora  quadrigemina  and  Irom  the  nucleus  of  the  pos- 
terior quadrigeminal  body.     In  all  likelihood  it  represents  the 


222  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

central  sensory  tract,  or  at  least  contains  a  good  share  of  it. 
(Figs.  62,  65,  66,  70,  and  72). 

The  fillet  then  passes  back  in  the  tegmentum  of  the  cms, 
the  pons,  and  the  oblongata.  On  its  way  it  gives  off  fibres  to 
the  opposite  nuclei  of  the  trigeminus,  the  acoustic,  the  glosso- 
pharyngeal, and  the  vagus.     (Figs.  127, 126, 125,  122,  and  121). 

In  the  medulla  oblongata  a  large  share  of  the  fibres  branch 
off  and  pass  dorsad  over  the  middle  line  to  the  nuclei  of  the 
posterior  columns, — internal  arciform  fibres.  (Figs.  120,  117, 
115,  lU.  Ill,  110,  and  109.)  • 

The  fibres  of  the  posterior  columns  run  caudad  from  the 
nuclei  of  these  columns.  Opposite  each  spinal-nerve  root  a  few 
fibres  are  given  off,  which  emerge  with  the  root  and  enter  the 
cells  of  the  spinal  ganglion.  From  these  cells  the  sensory  nerve 
arises. 

Those  fibres  of  the  fillet  which  are  left  after  the  tracts  to 
the  nuclei  of  the  posterior  columns  have  been  given  off  run 
backward  in  the  anterior  and  lateral  columns  of  the  spinal  cord. 
A  number  of  these  fibres  pass  off  to  the  gray  matter  opposite 
each  sensory  spinal  nerve,  traverse  it,  and  enter  the  opposite 
posterior  horn.  They  are  lost  in  the  net-work  of  cells  and  fibres 
at  that  point;  from  this  net- work,  however,  a  great  number  of 
the  sensory  fibres  arise.  They  all  terminate  directly  in  the 
spinal  ganglion,  and  from  this  the  sensory  fibres  arise.  (Figs. 
102.  100,  and  88). 

In  this  way  connections  are  established  between  all  the 
fibres  of  the  layer  of  the  fillet  and  the  nuclei  which  lie  on  the 
opposite  side.  A  portion  decussate  in  the  oblongata,  the  rest 
only  do  so  after  reaching  the  spinal  cord.  From  these  nuclei 
the  fibres  of  the  posterior  roots  are  given  ofi'. 

You  have  seen  that  the  motor  nerves  are  connected  directly 
with  the  cells  of  the  anterior  horn,  and  have  learned  that  a 
central  tract,  partly  direct  and  partly  crossed  (the  pyramids), 
arises  from  the  anterior  horns.  The  direct  part  (lateral  pyramidal 
tract)  passes  across  to  tlie  opposite  side  in  the  oblongata,  and  so 


THE    PONS FINAL    REVIEW.  223 

joins  the  other  part  which  had  ah*eady  crossed  in  the  spinal 
cord.     The  two,  united,  form  the  pyramids  of  the  oblongata. 

We  also  know  that  the  sensory  nerves  have  aij  analogous 
central  course.  The  nerve  first  passes  to  its  nucleus  in  the 
spinal  ganglion.  From  the  nucleus  a  direct  tract  is  developed, 
Avhich  passes  upward  in  the  posterior  columns.  In  the  oblongata 
it  passes  over  to  the  other  side.  Their  course  differs  from  that 
of  the  motor  nerves  in  that  they  pass  through  a  nucleus  (nucleus 
of  the  posterior  column)  before  decussating.  In  addition  to 
this,  there  is  given  off  from  the  spinal  ganglion  a  tract  which 
decussates  directly  after  entering  the  spinal  cord,  but  this  tract 
must  also  pass  through  the  unknown  mechanism  of  the  posterior 
horn. 

There  is  an  important  and  characteristic  difference  between 
the  ways  in  which  the  two  sets  of  nerves  are  connected  with 
their  prolongations  into  the  brain. 

The  connection  is  always  a  crossed  one,  but,  in  the  case  of 
the  sensory  nerve,  an  additional  apparatus  is  interposed  in  the 
cord,  between  the  nucleus  of  origin,  which  lies  outside  the  cord, 
and  tlie  central  tract.  With  a  motor  nerve  the  case  is  different ; 
its  nucleus  of  origin  already  lies  in  the  cord. 

7.  The  central  course  of  the  trigeminus  from  the  cortex  to 
tlie  capsule  is  unknown.  Its  fasciculi  must,  according  to  patho- 
logical experience,  lie  in  the  posterior  third  of  the  capsule. 
From  here  a  tract  must  pass  to  the  tegmental  nuclei,  the  most 
anterior  of  whicli  lies  under  the  corpora  quadrigemina,  in  the 
lateral  wall  of  the  aqueduct,  the  middle  one  in  the  midst  of  the 
pons,  and  tlie  most  posterior  extends  from  the  cervical  cord  u\) 
to  tlie  point  of  exit  of  the  nerve.  Near  the  point  of  exit  is 
situated  the  motor  nucleus  of  the  nerve.  Patholoiiv  tf^aches  us 
that  the  ascending  root  contains  the  sensory  fibres  for  the  face. 
The  central  tract  reaches  all  these  from  the  fillet  of  the  opposite 
side.  These  fibres  are  well  known  and  were  described  in  Lec- 
ture XI.  From  the  tri'^r'minal  nuclei  ;irise  the  roots  whose 
Bcnsory  portions  pass  into  ganglia  ((jasseriaii  ami  ciliary  ganglia. 


224  LECTURES    ON    THE    CENTRAL    NERVOUS    SYSTEM. 

etc.),  just  like  the  posterior  roots  of  the  spinal  nerves.  The  nerves 
arise  from  these  ganglia.  (Compare  Figs.  47,  72,  86,  109,  110, 
113,  114,  115,  125,  127,  128,  and  132.) 

8.  .As  to  the  cerebral  source  of  the  acoustic  nerve,  we  may 
assume  that  it  is  situated  somewhere  in  the  temporal  lobe,  that 
from  here  it  is  connected,  in  some  way,  with  the  posterior  por- 
tion of  the  capsule,  and  that  the  acoustic  tract  passes  on  in  that 
portion  of  the  fillet  which  originated  in  the  nucleus  of  the 
posterior  qnadrigeminal  body.  On  reaching  the  level  of  the 
acoustic  nucleus  it  passes  to  the  opposite  of  these  structures  in 
the  striae  acusticae.  There  are  two  acoustic  nuclei, — a  dorsal, 
Avhich  resembles  a  sensory  nucleus,  both  in  situation  and 
structure,  and  a  ventral,  which  has  a  somewhat  similar  structure 
to  tliat  of  the  spinal  ganglia.  From  its  relations  it  may, 
perhaps,  be  compared  to  one  of  the  latter.  Through  its  ventral 
nucleus,  the  acoustic .  nerve  is  connected  with  the  upper  olivary 
body.  From  the  latter,  fasciculi  run  to  the  cerebellum  and  to 
the  nuclei  of  the  ocular  muscles,  and  probably  farther  up  to 
more  anterior  regions  of  the  brain.  (Compare  Figs.  47,  65,  85, 
113,  121,  122,  125,  and  126.) 

The  trigeminus  and  the  acoustic  both  receive  fibres  from 
the  cerebellum. 

9.  Nothing  is  known  about  the  central  course  of  the  vagus 
in  the  fore-brain.  If  the  often-mentioned  region  in  the  posterior 
portion  of  the  capsule  is  destroyed,  no  symptoms  appear  which 
can  be  attributed  to  the  vagus.  Disturbance  of  the  sense  of  taste 
(glosso-pharyngeal)  is  present.  Reference  has  been  made  to 
the  course  of  the  fibres  from  the  fillet  to  the  opposite  nuclei  of 
the  vagus  and  glosso-pharyngeal.  These  nerves  also  apparently 
receive  a  tract  from  the  cerebellum. 

10.  The  central  course  of  the  optic  nerve  has  been 
explained  in  all  its  relations.  (Compare  Figs.  56,  57,  61,  62, 
66,  and  70.) 

I  will  again  remind  you  that  this  nerve  arises  from  the 
pulvinar  thalami,  the  corpus  geniculatum  laterale,  the  tuber 


THE    PONS FINAL    REVIEW.  '2'2') 

cinereum,  and,  mainly,  from  the  corpora  quadrigemiha.  Fibres 
iVom  the  optic  radiation,  which  commences  in  the  occipital  lobe, 
pass  to  all  these  sources.  This  radiation  passes  along-  the  outer 
side  of  the  posterier  horn  of  the  lateral  ventricle,  and,  therefore, 
in  its  passage  from  the  cortex  to  the  ])rimary  optic  centres,  it 
runs  under  the  lower  parietal  lobule.  Hence,  in  diseases  of  the 
latter,  or  when  it  has  been  experimentally  destroyed  in  animals, 
disturbances  of  vision  arise  which  resemble  those  of  cortical 
origin. 

The  fibres  of  the  optic  tract  run  to  the  chiasm.  There  the 
greater  part  of  tliem  cross  to  the  opposite  side.  A  small  portion, 
which,  however,  are  not  gathered  into  a  distinct  bundle,  remain 
on  the  same  side.  The  conflict  which  was  carried  on  for  vears 
over  the  chiasm  has  lately  been  definitely  settled  by  Singer  and 
Münzer,  with  the  results  given  above.  The  optic  tract  must 
contain  pupillary  fibres  coming  from  the  oculo-motor  nerve. 
It  is  not  yet  known  by  what  course  they  reach  the  former. 


INDEX. 


Abducens  nerve,  188,  207 
Accessory  nerve,  178,  188 
Accessory  olivary  process,  internal,  200 

posterior,  200 
Ala  cinerea,  191 
Amputation,  spinal-cord,  7-10 
Ansa  peduncularis,  91 

lentiformis,  88,  113 
Anterior  coUimns,  159 

horn  of  ventricle,  15 

horns,  152 

mixed  zone  of  lateral  column,  165 
Aqueduct  of  Sylvius,  96 
Arbor  vit:B,  136 
Arms  of  tlie  pons,  43,  132 
Association  fibres,  69 
Axis-cylinder,  41 

Baillarser's  line,  65 

Basal  fore-brain  bundle,  21,  79 

Brain,  emljrj'olotrv  of,  20 

peduncles  of, "27,  36.  85 
Brain-cortex,  comparative  anatomy,  22 

phvsiolosrv,  58 

histology."  63,  137 
Brain-sand,  96 
Broca's  convolution,  221 
Burdacb,  2,  12 
Burdach's  column,  162 

Calcar  avis.  53 
Capsule,  external,  38 

internal,  18,  37,  76,  80 
Central  convolutions,  48 

ventricular  gray  matter,  38,  91 
Centrum  semiovale,  31 
Cerebellar  peduncles,  132 

anterior,  105,  111,  132,  142 

middle.  132.  142 

posterior,    132.  142 
Cerei)ellum,  14,  2!),  34,  132 
Cei^vical   enlargement   of  spinal    cord, 

150 
Chiasm,  100 
(choroid  plexus  (fore-brain),  14 

Cafter-brain;,  137 
Cingulum,  71 

Clarke,  columns  of,  157,  170 
Claustrum,  38,  80 
ClavH,  iHl 

Columna  fornicis  Csee  also  Fornix),  52 
vesiculariH,  157.  170 


Commissura,  anterior   (fore-brain),  38, 

52,  71 
(spinal  cord),  167 

media,  36,  52,  91 

posterior,  36,  104 

thahimi  dorsalis,  26 
Conarium  (see  Pineal  gland) 
Conus  terminalis,  150 
Convolutions  of  cerebrum,  45 
Cornu  ammonis,  54,  55 
Corona  radiata,  24,  85 
Corpora  quadrigemina,  14,  34,  95,   105, 

106,  114,  121 
Corpus  callosum,  32,  52,  71 

ciliare  (dentatum),  138 

geniculatum  laterale,  26,  36,  89, 108 

geniculatum  mediale,  36,  108 

maraillare  (candicaus),  92,  93,  99 

opticum,  20 

restiforme,  132,  142,  195-198 

striatum,  16.  21,  78 

subthalamicum  (Luys),  93,  104 

trapezoides,  205 
Cortical  epilepsy,  70 
Crura  fornicis,  35 
Crusta,  27.  85,  97,  124,  126 
Culmen,  133 
Cuneus,  53 

Declivity,  the,  133 

Decussating  commissure,  anterior,  139, 
143,  144 
posterior,  144 
zone,  142 
Degeneration,  secondary,   6,   147,   159, 

162 
Deiter's  nucleus,  208 

cells,  159 
Dendritic  tracts,  142 
Direct  sensory  cerebellar  tract,  143,  192, 
203 

Ehreiiberg,  2 

Embolus,  138     " 

Embryolo;;;y  of  central  nervous  system, 

13 
Embryonic  lamina  terminalis,  13 
Epiphysis,  20,  25,  35,  96 

Facial  nerve.  188.  204,  207 
Fascia  dental  a,  55 
Fasciculus  anlero-lateralis,  164 

(227) 


'228 


INDEX. 


Fasciculus  arcuatis,  71,  73 

longitudinalis,  inferior,  71 
posterior,  120,  300 

retroflexus,  131 

uncinatus,  41 
Fibrse  arciforuies,  142,  195 
intern  86,  183 

proprise  (of  the  cortex),  68 
Fifth  nerve,  ascending  root,  177 

descending  root,  122 
Fillet,  36,  95,  104,  113,  321 
Filuiu  terminale,  150 
Fimbria,  54 
Fissura  calcariua,  53 

hippocampi,  54 

occipito-temijoralis,  57 

parieto-occipitalis,  53 

Sylvii,  15,  45 
Flechsig,  7 
Fleece,  the,  143 
Flocculus,  135 
Folium  cacuminis,  134 
Foramen  of  Magendie,  138,  187 

of  Monro,  34 
Fore-brain,  secondary,  14 
Formatio-reticularis,  302 
Fornix,  16,  35,  51 

Fountain  like  decussation  of  the  teg- 
mentum, 114,  124 
Frontal  lobe,  24,  48 
Funiculus  gracilis,  163 

cuneatus,  162 
Furrows  of  cerebrum,  45 

Ganglion-cells,  40 

Ganglion  habenulse,  26,  36 

Ganglionic  ridge,  19 

Gaskell,  39 

Gasserian  ganglion,  323 

Gelatinous  cortical  layer,  158 

Gennari,  line  of,  65 

Gland,  pineal,  30,  35,  35,  96 

Globus  pallidus,  38,  86 

Glosso-]>haryngeal     nerve,     188,     191, 

234 
Goll's  tract,  163,  182 
Granular  layer,  138 

Ground-bundle    of   posterior    column, 
162 

of  anterior  column,  165 
Gudden,  7 

Gudden's  commissure,  108 
Gyrencephalous  manigials,  23 
Gyri  insulse,  48 
Gyrus  angularis,  49 

centralis  ant.  et  post.,  48 

dentatus,  54 

formicatus,  53-55 

hippocampi,  53-55 

marginalis,  49 

occipito -temporalis,  57 

uncinatus,  52 


Hannover,  3 

Hearing,  nerve  of,  108,  188,  304,  331 
Hemispheres  of  cerebellum,  134,  135 
History  of  investigation  of  the   brain, 

1-11 
Horns  of  lateral  ventricle,  15 
Hypoglossal  nerve,  188,  193,  201,  220 

central  tract  of,  74,  220 
Hypophisis,  35,  100 

Inferior  horn  of  ventricle,  15,  199 
Inferior  longitudinal  fasciculus,  71 
Infundibulum,  35,  38,  100 
Inter-brain,  13,  14,  25,  74,  89 
Inter-olivary  layer,  184,  198 
Intumescentia  cervicalis,  150 

lumbalis,  150 
Island  of  Reil,  38,  46 

Knee  of  corpus  callosum..  -^2 
of  internal  capsule,  80 

Lamina  medullaris  thalami,  tL'# 

terminalis,  101 
Laqueus,  26,  95,  104,  113,  321 
Lateral  cerebellar  tract,  164,  195 

columns,  159 
Latticed  layer,  90 
Lemniscus  (see  Laqueus) 
Lenticular  nucleus,  18,  38,  78 

divisions  of,  86,  87 
Limiting  layer  of  gray  matter,  165 
Lingula,  133 

Lisencephalous  mammals,  23 
Lobes  of  cerebellum,  133 
Lobi  optici,  26 
Lobus  centralis,  133 
cuneiformis,  135 
frontalis,  24,  48 
gracilis,  135 
■   lingualis,  53 
occipitalis,  50 
olfactorius,  100 
parietalis,  49 
posterior  inferior,  135 
quadrangularis,  134 
semilunaris  inferior,  185 

superior,  134 
temporalis,  48 
Localization    and    symptomatology   of 
disease  in: — 
the  cortex,  57 
the  central  ganglia,  102 
the  cerebellum,  145 
the  quadrigeminal  region,  134 
the  spinal  cord,  150,  173 
the  oblongata  and  pons,  315 
the  white  substance,  81 
Locus  cceruleus,  310 
Longitudinal  fissures  (spinal  cord),  152 
Lumbar  enlargement       "  "       150 

Luys,  body  of,'  93,  104 


INDEX. 


229 


Margin  of  hemisphere,  14 
Mai  riuul  convolution,  55 
Marrow,  deep,  27,  114 
Medulla  oblongata.  29,  176 

spinalis,  27,  150 
Medullary  sheath  in  spinal-cord,  158 

structure  of,  8 
Methods   of   investigating  the   central 

nervous  system,  4-14 
Meynert's  bundle,  121 
Mid-brain,  1:3,  84,  95,  120 
Motor  area  of  tegmentum,  199 

nuclei   of  cranial  nerves,  190,  222, 
etc. 

roots,  147,  201,  222 

speech-tract,  74,  221 

Nerve-fibres,  40 

two  forms  of  origin  of,  41 
Neuroglia,  39  ** 

Nodulus,  134 
Nuclei  acustici,  204 
Nuclei  of  the  thalamus,  89 

of  trigeminus,  209,  210 

of  trochlear  nerve,  130 
Nucleus  ambiguus,  191 

amygdalae,  38 

arciformis,  196 

caudatus,  18,  34,  77 

dentatus,  138 

fastigii,  144 

funiculi  gracilis.  181,  182 
cuneati,  181,  182 

globosus,  138 

lemnisci,  212 

lentiformis,  18,  38,  78,  86 

of  abducens,  207 

of  accessory  nerve,  178 

of  facial  nerve,  204 

of  glossopharyngeal  nerve,  191 

of  oculo-motor  nerve,  115 

of  hypoglossal  nerve,  193 

pyramidalis,  201 

reticularis  tegmenti,  203 

ruber,  93,  94" 

Oblongata,  29,  176 
Occipital  lobe,  50 

sulci,  50 
Oculo-motor  nerve,  115,  188 
Olfactory  nerve,  25,  100 

bull),  25 
Olivary  body,  inferior,  176,  184,  197 

superior,  205 
0|»erculum,  47 
Optic  nerve,  26,  100,  108,  224 

Pallium,  21 
Paracentral  lobule,  53 
Parietal  lobe,  49 

oriran,  26 
Pedicle  of  thalamus,  74 


Pedunculi  cerebelli,  132      , 
cerebri,  27,  36,  85 
conarii,  36,  96 
corporis  mamillaris,  92 
Pes  hippocampi  major,  54 
minor,  53 
pedunculi,  27,  85,  97,  124,  126 
Plexus  choroideus  (fore-brain),  14 

(after-brain),  137 
Pons,  14,  29,  74,  98,  127,  215 
Posterior  columns,  159 

nuclei  of,  181,  182 
Posterior  horns,  152 
head  of  177 
neck  of,  177 
roots  of  spinal  cord,  147,  156,  167, 
224 
Pnecuneus,  53 
Processus  protoplasmalici,  42 

reticularis,  153 
Pulvinar,  36.  89 
Purkinje,  cells  of,  138 
Putamen,  38,  79,  «6 
Pyramidal  column,  180.  198 

tract,  74,  98,  111,  219,  222,  etc.      ♦ 
in  anterior  column,  160,  222 
in  lateral  column,  160,  223 
Pyramis  cerebelli,  135 

Raphe,  199 

Rays,  21 

Red  nucleus,  93,  94 

Regio  subthalamica,  88,  93 

Reil,  2 

Remak,  2 

Remnant  of  antero-lateral  column,  165 

Respiration  bundle,  191 

Rhomboidal  fossa,  96,  175.  187 

Saccus  vasculosus,  25 
Secondary  degeneration,  6,  160,  161 
Sensory  nuclei  of  cranial  nerves,    191, 
200.  201.  223 

roots,  18,  147,  156,  223 
Septum  pellucidum,  16,  34,  51 
Speech -tract,  74,  221 
Spider-cells,  159 
Spinal  cord,  28,  149 

segmentation  of,  151,  155 

ganglia,  147 
Splenium,  52 
Stilling,  2-4 

Stratum     complexum     et     profundum 
pontis,  127 

intermedium  (Meynert's),  111 

sui)erficiale  pontis,  127 

zonale,  89 
Stria  medullaris,  36 

longitudinalis  F.ancisi,  56 

terminal  is,  36 
StriiP  acMsticie,  207 
Substantia  gelatinosa  centralis,  158 


230 


INDEX. 


Substantia  gelatinosa  Rolandi,  158 

innominata,  Ql 

nigra,  95 

perforata,  anterior,  100 
posterior,  98 

reticularis,  130 
Sulcus  calloso-marginalis,  53 

centralis,  48 
insulae,  47 

interparietalis,  50 

olfactoi-ius,  56 

orbitalis,  56 

prsecentralis,  48 
Sylvius,  fissure  of,  15,  45 

Tangential  fibres  of  cortex,  65 
Tapetum,  73 

Tegmental  bundle  of  corpus  mamillare, 
93 

radiation,  75,  87,  91,  113,  331 

tract,  central,  301 
Tegmentum,  37,  85,  111,  133,  139 

motor  area  of,  199 
Temporal  convolutions,  48 

lobe,  48 
Thalamic  s;anglia,  85 
Thalamus,"  14,  34,  74,  89 
Tonsilla  (cerebelli),  135 
Tractus  intermedio-lateralis,  153 

olfactorius,  35,  100 


Tractus  opticus,  26,  89,  100 
Trigeminus  nerve,  188,  209,  333 
Trochlear  nerve,  130,  188 
Tuber  cinereum,  35,  38,  100 

olfactorium,  100 

valvulse,  135 
Tuberculum  acusticum,  204 

anterius,  36 

Uvula  (cerebelli),  134 

Vagus.  188,  191,  334 

Velum  medulläre  anticum,  134,  136 

posticum,  31,  137,.  187 
Ventricle,  14,  15,  33 
Ventriculus  lateralis,  14,  15,  33 

quartus,  96,  127,  140, 176,  187 

septi  pellucidi,  34 
Vermis,  132,  133 
Vicq  d'Azyr's  bundle,  93 

White  substance,  158 

of  cerebrum,  31 

of  hemispheres  of  cerebellum,  135 

of  vermis,  133 
Worm,  133,  133 

Zona  spongiosa,  169 

terminalis,  169 
Zone  of  anterior  horn  (His"i.  29 


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INDEX  TO  CATALOGUE. 


PAGE 

Annual   of    the   Universal    Medical 

Sciences  ....'. 27,  28,  29 

Anatomy. 

Practical  Anatomy — Boenning 4 

Structure  of  the  Central  Nervous  Sys- 
tem— Edinger 8 

Charts  of  the  Nervo- Vascular  System — 

Price  and  Eagleton 17 

Synopsis  of  Human  Anatomy — Young  .   .  25 

Bacteriology. 

Bacteriological  Diagnosis — Eisenberg  .  .       8 

Clinical  Charts. 

Improved  Clinical  Charts — Bashore  ...       3 

Consumption. 

Consumption :  How  to  Prevent  it,  etc. — 
Davis 7 

Domestic  Hygiene,  etc. 

The  Daughter :  Her  Health,  Education, 

and  Wedlock — Capp 5 

Consumption :  How  to  Prevent  it,  etc. — 
Davis 7 

Plain    Talks    on   Avoided    Subjects- 
Guernsey    9 

Heredity,  Health,  and  Personal  Beauty — 
Shoemaker     21 

Electricity. 

Practical  Electricity  in  Medicine  and 
Surgery— Liebig  and  Rohe 12 

Electricity  in  the  Diseases  of  "Women — 
Massey 13 

Fever. 

Fever :   its    Pathology    and    Treatment — 

Hare 10 

Hay  Fever— Sajous 19 

Gynecology. 

Lessons  in  Gynecology— Goodell 9 

Heart,  Lungs,  Kidneys,  etc. 

Diseases   of    the   Heart,    Lungs,    and 

Kidneys— Davis 7 

Diseases  of  the  Heart  and  Circulation  in 
Children— Keating  and  Edwards  ...     12 

Diabetes :    its   Cause,    Symptoms,    and 

Treatment— Purdy 17 

Hygiene. 

American  Resorts — James 11 

Text-Book  of  Hygiene— Rohe 18 

Materia  Medica  and  Thera- 
peutics.   ■ 

Hand-Book  of  Materia  Medica,  Phar- 
macy, and  Therapeutics— Bowen  ...      4 

Ointments  and  Oleates— Shoemaker   ...     21 

Materia  Medica  and  Therapeutics— Shoe- 
maker         22 

International  Pocket  Medical  Formulary 
— Witherstine 26 


Miscellaneous. 

PAGE 

Book  on  the  Physician  Himself— Cathell .  5 

Oxygen — Demarquay  and  Wallian    ....  7 
Record-Book   of    Medical  Examinations 

for  Life  Insurance— Keating 11 

The  Medical  Bulletin,  Monthly 13 

Physician's  Interpreter 15 

Circumcision— Remoiidino 18 

Medical  Symbolism— Sozinskey 23 

International  Pocket  Medical  Formulary 

—Witherstine 26 

The   Chinese :    Medical,   Political,    and 

Social— Coltman 31 

A,  B,  C  of  the  Swedish  System  of  Educa- 
tional Gymnastics — Nissen 32 

Lectures  on  Auto-Intoxication — Bouchard  32 

Nervous  System,  Spine,  etc. 

Spinal  Concussion — Clevenger    .....  6 

Structure  of  the  Central  Nervous  System 

— Edinger 8 

Epilepsy  :  its  Pathology  and  Treatment- 
Hare  10 

Lectures  on  Nervous  Diseases— Ranney    .  39 

Obstetrics. 

Childbed  :  its  Management :  Diseases  and 

Their  Treatment— Manton 13 

Eclampsia— Michener  and  others 15 

Obstetric  Synopsis— Stewart 24 

Pharmacology . 

Abstracts  of  Pharmacology— Wheeler  .  .     25 

Physiognomy. 

Practical  and  Scientific   Physiognomy — 

Stanton 39 

Physiology, 

Physiology  of  the  Domestic  Animals — 
Smith 23 

Surgery  and  Surgical  Operations. 

Circumcision — Remondino 18 

Principles  of  Surgery— Senn 20 

Swedish  Movement  and  Massage. 

Swedish  Movement  and  Massage  Treat- 
ment— Nissen 15 

Throat  and  Nose. 

Journal  of  Laryngology  and  Rhinology    .  11 

Hay  Fever— Sajous 19 

Diphtheria,  Croup,  etc. — Sanne 19 

Lectures  on  the  Diseases  of  the  Nose  and 

Throat— Sajous 31 

Venereal  Diseases. 

Syphilis  :  To-day  andän  Antiquity— Buret      4 
Neuroses  of  the  Gen ito-Uri nary  System 
in  the  Male— Ultzmann 24 

Veterinary. 

Age  of  the  Domestic  Animals— Huide- 
koper 32 

Physiology  of  the  Domestic  Animals — 
Smith 23 

Visiting-Lists  and  Account- 
Books. 

Medical  Bulletin  Visiting-List  or  Physi- 
cians' Call-Record 14 

Physicians'  All-Requisite  Account-Book  .     16 


(2) 


Bäshore's  Improved  Clinical  Chart. 


For  the  SEPARATE  PLOTTINa  of  TEMPERATURE,  PULSE,  and  RESPIRATION. 

(  Convenient,   Accurate,   and  Permanent  Daily   Recorc 
Hospital  and  Private  Practice. 

By  HARYEY  B.   BASHORE,  M.D. 


Designed  for  the  Convenient,   Accurate,   and  Permanent  Daily   Recording  of  Cases  in 
Hospital  and  Private  Practice. 


OOPTRIOHTED,   1888,  BY  F.  A.  DAVIS. 

SO  OlJ-a-rts,  iix  TaTolet  r'orm..  Size,  S  2E  12  ixicls.es. 


Prioe,  in  the  United  States  and  Canada,  Post-paid,  50  Cents, 
Net ;  Great  Britain,  2s.  6d. ;  France.  3  fr.  60. 

The  above  diagram  is  a  little  more  than  one-fifth  (1-5)  the  actual  size  of  the  chart  and  shows  the 
method  of  plouinR,  the  upper  curve  being  the  Temperature,  the  middle  the  Pulse,  and  the  lower  the 
Respiration.     By  iHi«  method  a  fulJ  record  of  each  can  easily  be  kept  with  but  one  color  ink 

It  is  so  arranged  that  all  practitioners  will  find  it  an  invalimble  ;iid  in  tho  treatment  of  their  patients. 

f)n  the  back  of  each  chart  will  be  found  ample  space  conveniently  arranged  for  recording  "Clinical 
History  and  Symptoms"  and  "Treatment  "  ,         .1    .- 

By  its  use  the  physician  will  secure  such  a  complete  record  of  his  ca.ses  as  will  enable  hirri  to  review 
them  at  any  time.  Thus  he  will  always  have  at  hand  a  source  of  individual  improveuient  and  benelil  m 
the  practice  of  hi»  profession,  the  value  of  which  can  hardly  be  overestimated. 


(F.  A.  D  Alf  IS.  Medical  Publisher.  Philadelphia,  Pa.,  U.S.  A.) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia, 


A  Text-Book  on  Practical  Anatomy. 

Including  a  Section  on  Surgical  Anatomy. 

B}^  Henry  C.  Boenning,  M.D.,  Lecturer  on  Anatomy  und  Surgery 
in  the  Philadelphia  School  of  Anatomy ;  Demonstrator  of  Anatomy  in 
the  Medico-Chirurgical  College ;  Demonstrator  of  Anatomy  in  the 
Philadelphia  Dental  College ;  Lecturer  on  Diseases  of  the  Rectum  in 
the  Medico-Chirurgical  College,  etc,  etc. 

Fully  illustrated  throughout  with  about  200  Wood-Engravings. 
In  one  handsome  Octavo  volume,  printed  in  extra-large,  clear  ty\)e., 
making  it  specially  desirable  for  use  in  the  dissecting  room.  Nearly 
500  pages.  Substantially  bound  in  Extra  Cloth.  Also  in  Oil-Cloth,  for 
use  in  the  dissecting-room  without  soiling. 

Price,  post-paid,  in  the  United  States,  $2.50,  net;  Canada  (duty  paid),  $2.75,  net; 
Great  Britain,  Us. ;  France,  16  fr.  20. 


BOWEJ!>r 

Hand-Book  of  Materia  Medica,  Pharmacy, 
and  Therapeutics. 

By  CuTHBERT  BowEN,  M.D.,  B.A.,  Editor  of"  Notes  on  Practice." 
The  second  volume  in  the  Physicians''  and  Students''  Ready  Refer- 
ence Series.     One  i2mo  volume  of  370  pages.     Handsomely  bound  in 
Darli-Blue  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.40,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  fr.  25. 

EXTRACT  FROM  THE  PREFACE — "  While  this  is  essentially  a  Student's  Manuai,, 
a  large  amount  of  matter  has  been  incorpoi-ated  which,  it  is  hoped,  will  render  it  a  useful  refer- 
ence-book to  the  Young  Graduate  who  is  just  entering  on  his  professional  career,  and  more 
particularly  the  individual  whose  sphere  of  work  demands  a  more  practical  acquaintance  with 
pharmaceutical  processes  than  is  required  of  the  ordinary  city  practitioner.  Great  care  has 
been  taken  throughout  the  book  to  familiarize  the  student  witli  the  best  methods  of  administer- 
ing the  various  drugs  he  will  be  called  upon  to  use,  and  with  this  object  a  large  number  of 
standard  prescriptions  have  been  selected  from  the  works  of  the  most  eminent  authorities, 
which  he  can  either  adopt,  with  modifications  to  suit  particular  cases,  or  use  as  models  on  which 
to  construct  his  own  formulae." 


This  excellent  manual  comprises  in  its  366 
pages  about  as  much  sound  and  valuable 
information  on  the  subjects  indicated  in  its 
title  as  could  well  be  crowded  into  the  com- 
pass. The  book  is  exhaustively  and  correctly 
indexed,  and  of  a  convenient  form.  The  paper, 
press-work,  and  binding  ai-e  excellent,  and  the 
typography  (long  primer  and  brevier)  is  highly 
to  be  commended,  as  opposed  to  the  nonpareil 
and  agate  usually  used  in  eompends  of  this 


sort,  and  which  are  destructive  to  vision  and 
temper  alike. — 8t.  Louis  Med.  and  Surg.  Jour. 

In  going  through  it,  we  have  been  favorably 
impressed  by  the  plain  and  practical  sugges- 
tions in  regard  to  prescription  writing,  and 
the  metric  sy.stem,  and  the  other  things  which 
must  be  known  in  order  to  write  good  and  ac- 
curate prescriptions. — Medical  and  Surgical 
Heporter 


BURET 

Syphilis  :  To-day  and  in  Antiquity. 

By  Dr.  F.  Buret  (Paris).  Translated  from  the  French,  with  the 
author's  permission,  by  A.  H.  Ohmann-Dumesnil,  A.M.,  M.D.,  Professor 
of  Dermatology  and  Syphilology  in  the  St.  Louis  College  of  Physicians 
and  Surgeons. 

To  be  completed  in  three  12mo  volumes.  Volume  I,  Syphilis  in 
i"tiquity.     In  Press.     Ready  in  October,  1891. 

(4) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


CAPP 


Her  Health,  Hducation,  and 
^Wedlock. 


The  Daughter. 

Homely  Suggestions  to  Mothers  and  Daughters. 


B}'  William  M.  Capp,  M.D.,  Philadelphia.  This  is  just  such  a  book 
as  a  fainil}-  i)hysician  would  advise  his  lady  patients  to  obtain  and  read. 
It  answers  man}'  questions  which  ever}'  busy  practitioner  ot"  medicine 
has  put  to  him  in  tlie  sick-room  at  /i  time  when  it  is  neither  expedient 
nor  wise  to  impart  the  information  sought. 

It  is  complete  in  one  beautifully  printed  (large,  clear  type)  12mo 
volume  of  150  pages.     Attractively  bound  in  Extra  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net ;  In  Clreat 
Britain,  5s.  6i ;  France,  6  fr.  20. 


In  the  1-14  pages  allotted  to  liim  he  has  com- 
pressed an  axiiount  of  homely  wisdom  on  the 
pliysicaL,  inent:il,  and  moral  "development  of 
the  female  child  from  birth  to  maturity  which 
is  to  be  found  elsewhere  in  only  the  great 
book  of  experience.  It  is,  of  course,  a  jjook 
for  mothers,  but  is  one  so  void  of  otfense  in 
expression  or  ideas  that  it  can  safely  be  recom- 
mended for  all  whose  minds  are  sufficiently 
developed  to  appreciate  its  teachings. — Phila- 
delphia Public  Ledger. 

Many   delicate   subjects   are    treated   with 


skill  and  in  a  manner  which  cannot  strike  any 
one  as  inipi'oper  or  bold.  The  absolute  ignor- 
ance in  which  most  young  girls  are  allowed  to 
exist,  even  until  adult  life,  is  often  pnjductive 
of  much  misery,  both  mental  and  physical. 
Quite  a  number  of  books  written  by  physi- 
cians for  popular  use  have  been  prepared  in 
such  a  way  that  the  professional  man  can  read 
between  the  lines  strong  bids  for  popular 
favor,  etc.  These  objectionable  features  will 
not  be  found  in  Dr.  Capp's  brochure,  and  for 
this  reason  it  is  worthy  the  confidence  of 
physicians. — Medical  News. 


CATHBLL 

Book  on  the  Physician  Himself 

And  Things  that  Concern  his  Reputation  and  Success. 

By  D.  W.  Cathell,  M.D.,  Baltimore,  Md.  Being  the  Ninth  Edition 
(enlarged  and  thorouglil}'  revised)  of  the  "  Physician  Himself,  and  what 
he  should  add  to  his  Scientific  Acquirements  in  order  to  Secure  Success." 
In  one  handsome  Octavo  Volume  of  298  pages,  bound  in  Extra  Cloth. 

Thousands  of  physicians  have  won  success  in  their  chosen  profession 
tlirough  the  aid  of  this  invaluable  work. 

This  remarkable  book  has  passed  through  eight  (8)  editions  in  less 
than  five  years.  It  has  just  undergone  a  thorough  revison  by  the  autlior, 
who  has  added  much  new  matter  covering  many  points  and  elucidating 
many  excellent  ideas  not  included  in  former  editions. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net;  in  Great 
Britain,  Us.  6i;  France,  12  fx.  40. 


I  am  most  favorably  impress<'d  with  the 
wi.sdoni  and  ('orce  of  the  points  m;idc,  in  "Tlie 
Physician  Himself,"  and  believe  the  work  in 
the  hands  of  a  young  graduate  will  greatly  en- 
hance his  chanees  foi-  profcKsional  success. — 
From  Prof.  D.  Hayes  Aynew,  Philu.,  Pa. 

We  strongly  advise  every  actual  and  intend- 
ing practitioner  of  medicine  or  surgery  to  have 
"  i  he  Physician  Himself,"  and  the  more  it  in- 
fluences his  future  conduct  the  lictter  he  will 
be. — from  the  ('anadu  Medical  and  Surgical 
Journal,  Montreal. 

In  the  present  edition  the  entire  work  has 
been  revised  and  some  new  matter  introduced. 
The  pulilislier's  part  is  well  done;  paper  Is 
good  and  the  print  birgo  ;  altogether  it  is  a 
very  r<-a<l:ible  and  enjoyable  book.— Montreal 
Medical  Journal 


I 
(6) 


We  have  read  it  carefully  and  regret  much 
that  we  had  not  done  so  earlier  and  followed 
its  precepts.  The  book  is  full  of  good  adviee. 
<iet  it  at  once. — Pacific  llecord  of  Medicine 
and  Surgery. 

We  cannot  imagine  a  more  profitable  invest 
ment  for  the  junior  practitionci-  than  the  juir- 
chase  and  careful  study  of  "The  Physiciai; 
Himself." — Occidental  Medical  Times.' 

To  the  physician  who  has  discovered  tha<. 
there  is  something  else  besides  dry  book-learn 
ing  needed  to  make  him  a  desiraiile  visitor  at 
the  bedside,  we  eoinmend  this  volume,  that  he 
may  assimilate  some  of  the  nrady  (Tystallized 
worldly  wisdom  whieli  otherwise  he  may  bo 
many  years  :i('(|iiiring  by  natural  processes. — 
North' Carolina  Medical  Journal. 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


CLJEVENGER 

Spinal  Concussion. 

Surgically   Considered  as  a   Cause  of   Spinal  Injury,  and  Neuro- 

logically  restricted  to  a  certain  symptom  grroup,  eor  which 

IS  Suggested  the   Designation   Erichsen's  Disease, 

AS  One  Form  of  the   Traumatic  Neuroses. 

By  S.  y.  Clevenger,  M.D.,  Consulting  Physician  Reese  and  Alexian 
Hospitals;  Late  Pathologist  County  Insane  Asylum,  Chicago;  Member 
of  numerous  American  Scientific  and  Medical  Societies ;  Collaborator 
American  Naturalist,  Alienist  and  Neurologist,  Journal  of  Neurology 
and  Psychiatry,  Journal  of  Nervous  and  Mental  Diseases ;  author  of 
"  Comparative  Ph3'Siology  and  Psychology,"  "  Artistic  Anatomy,"  etc. 

This  work  is  the  outcome  of  five  3'ears' special  study  and  experience 
in  legal  circles,  clinics,  hospital  and  private  practice,  in  addition  to 
twenty  years'  labor  as  a  scientific  student,  writer,  and  teacher. 

The  literature  of  Spinal  Concussion  has  been  increasing  of  late  years 
to  an  unwield}^  shape  for  the  general  student,  and  Dr.  Clevenger  has  in 
this  work  arranged  and  reviewed  all  that  has  been  done  by  observers 
since  the  da^s  of  Erichsen  and  those  who  preceded  him. 

There  are  abundant  illustrations,  particularly  for  Electro-diagnosis, 
and  to  enable  a  clear  comprehension  of  the  anatomical  and  pathological 
relations. 

The  Chapters  are:  I.  Historical  Introduction;  II.  Erichsen  on 
Spinal  Concussion;  III.  Page  on  Injuries  of  the  Spine  and  Spinal  Cord; 
IV.  Recent  Discussions  of  Spinal  Concussion  ;  V.  Oppenheim  on 
Traumatic  Neuroses ;  YI.  Illustrative  C-ases  from  Original  and  all  other 
Sources;  Yll.  Traumatic  Insanity;  VIII.  The  Spinal  Column;  IX. 
Symptoms;  X.  Diagnosis;  XI,  Pathology;  XII.  Treatment;  XIII. 
Medico-legal  Considerations. 

Other  special  features  consist  in  a  description  of  modern  methods 
of  diagnosis  by  Electricity,  a  discussion  of  the  controversy  concerning 
hysteria,  and  the  author's  original  pathological  view  that  the  lesion  is 
one  involving  the  spinal  sympathetic  nervous  s^-stem.  In  this  latter 
respect  entirely  new  ground  is  taken,  and  the  diversity  of  opinion  con- 
cerning the  functional  and  organic  nature  of  the  disease  is  aflTorded  a 
basis  for  reconciliation. 

Every  Physician  and  Lawyer  should  own  this  work. 

In  one  handsome  Royal  Octavo  Volume  of  nearly  400  pages,  with 
thirty  Wood-Engravings. 

Price,  post-paid,  in  united  States  and  Canada,  $2.50,  net;  in  Great 
Britain,  14s. ;  in  France,  15  fr. 


The  reader  will  find  in  this  book  the  best 
discussion  and  summai-y  of  the  facts  on  this 
topic,  whicli  will  make  it  very  valnalile  to 
every  physician.  For  the  specialist  it  is  a 
text-book  that  will  be  often  consulted. — 77ie 
Journal  of  Inebriety. 

The  work  conies  fully  up  to  the  demand, 
and  the  law  and  medical  library,  to  be  com- 
plete, cannot  be  without  it. — Southern  Medical 
Jiecord. 


This  work  really  does,  if  we  may  be  per- 
mitted to  use  a  trite  and  hackneyed  expres- 
sion, "fill  a  long-felt  want."  The  subject  is 
treated  in  all  its  bearings  ;  electro-diagnosis 
receives  a  large  share  of  attention,  and  the 
chapter  devoted  to  illustrative  cases  will  be 
found  to  posse.ss  especial  importance.  The 
author  has  some  original  views  on  jjathology. 
— Medical  Weekly  Review. 


(6) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


Consumption: 


DAVIS 

How  to  Prevent  it,  and  Hoijv 
to  Lrive  vtrith  it. 


Its  Nature,   Causes,  Prevention,  and  the   Mode  of   Life,  Climate, 
Exercise,  Food  and  Clothing  Necessary  for  its  Cure. 

By  N.  S.  Davis,  Jr.,  A.M  ,  M.D.,  Professor  of  Principles  and  Practice  of 
Medicine  in  Chicago  Medical  College;  Physician  to  Mercy  Hospital;  Member  of 
the  American  Medical  Association,  Illinois  State  Medical  Society,  etc.,  etc. 

12mo.    In  Press. 

DAVIS 

Diseases  of  the  Heart,  Lungs,  and  Kidneys. 

By  N.  S.  Davis,  Jr.,  A.M.,  M.D.,  Professor  of  Principles  and  Practice  of 
Medicine  in  Cliicajio  Medical  Collejic;  Physician  to  Mercy  Hospital;  Member  of 
the  American  Medical  Association,  Illinois  State  Medical  Society,  etc.,  etc. 

In  one  neat  12mo  volume.  No.  in  the  Physicians'  and  Students'  Beady- 
Reference  Series.    In  Preparation. 

Di:3IAIlQUAT 

A  Practical  Investigation  of  the  Clinical 
On    OxyOen.  and  Xnerapeutic  value  of  tlie  case» 

^  in  Medical  and  Surgfical  Practice, 

With  Especial  Reference  to  the  Value  and  Availability  op  Oxygen, 
Nitrogen,  Hydrogen,  and  Nitrogen  Monoxide. 

By  J.  N.  Demarquay,  Surgeon  to  the  Municipal  Hospital,  Paris,  and  of  the 
Council  of  State;  Member  of  the  Imperial  Society  of  Surgery;  Correspondent  of 
the  Academies  of  Belgium,  Turin,  Munich,  etc  ;  Officer  of  the  Legion  of  Honor, 
Chevalier  of  the  Orders  of  Isabella-the-Catholic  and  of  the  Conception,  of 
Portugal,  etc.  Translated,  with  notes,  additions,  and  omissions,  by  Samuel  S. 
W.\LLIAN,  A.M.,  M.D.,  Member  of  the  American  Medical  Association;  Ex-Presi- 
dent of  the  Medical  Association  of  Northern  New  York;  Member  of  the  New 
York  County  Medical  Society,  etc. 

In  one  handsome  Octavo  Volume  of  316  pages,  printed  on  fine  paper,  in 
the  best  style  of  the  printer's  art,  and  illustrated  with  21  Wood-Cuts. 

Price,  post-paid,  in  United  States,  Cloth,  $2.00,  net ;  Half-Russia,  $3.00, 
net.  In  Canada  (duty  paid).  Cloth,  $2.20,  net;  Half-Bussia,  $3.30, 
net.  In  Grreat  Britain,  Cloth,  lis.  6d. ;  Half-Eussia,  17s.  6d.  In 
France,  Cloth,  12  fr.  iO;  Half-Russia,  18  fr.  60. 

For  some  years  past  there  has  been  a  growing  demand  for  something  more 
satisfactory  and  more  practical  in  the  way  of  literature  on  the  subject  of  what 
has,  by  common  consent,  come  to  be  termed  "Oxygen  Therapeutics. "  On  all 
sides  i)rofe8sional  men  of  standing  and  ability  are  turning  their  attention  to  the 
use  of  the  gaseous  elements  about  us  as  remedies  in  disease,  as  well  as  sustainers 
in  health  In  prosecuting  their  inquiries,  tlie  first  hindrance  has  been  the  want 
of  any  reliable,  or  in  any  degree  satisfactory,  literature  on  the  subject. 

This  work,  translated  in  tlie  main  from  the  French  of  Professor  Demarquay, 
contains  also  a  very  full  account  of  recent  English,  (Jerman,  and  American  ex- 
periences, prepared  by  Dr.  Samuel  S.  Wallian,  of  New  York,  whose  experience 
in  this  field  antedates  that  of  any  other  American  writer  on  the  subject. 


Tili«  m  a  handHome  volume  of  300  page«,  in 
larK«  print,  on  jrood  pafifr,  and  nici-ly  illii.s- 
tratftd.  Altliouuli  nominally  plcadinp;  (or  the 
usfiof  oxv(;''n  inhalations,  the  auth<ir  >howH  in 
a  pliilomiphical  mann<;r  how  mufdi  au'alo.r 
good  phvHifian»  nii«ht  'lo  'f  th«y  nioi  f!  fully 
apprf;<;ia'ti-<l  tli«-  valiu^  of  frc-«h  alroxiMCiHc;  and 
watpr,  csi)f;cially  in  <l\ni-,ism  of  thf;  lun^H,  kid- 
nevH,  and  skin.  Wc  coinnifinrl  it«  pcniKal  to 
our  reatler».— 27ic  Canada  Medical  liecord. 


Tho  hook  should  he  vvididy  read,  for  to  many 
it  will  hrint;  the  addition  of  a  new  weapon  to 
their  therapeutic  arnianient. — Northwestern 
Lancet. 

AltoRether  the  hook  is  a  valuable  one,  which 
will  be  found  of  service  to  the  busy  prac- 
titioner who  wishes  to  keep  abreast  of  the 
improvements  in  therapeutics.  —  Medical 
New». 


(7) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


JEISBJSTBEBG 

Bacteriological  Diagnosis. 

Tabular  Aids  tor  Use  in  Practical  Work. 

By  James  Eisenberg,  Ph.D.,  M.D.,  Vienna.  Translated  and  aug- 
mented, with  the  permission  of  the  author,  from  the  latest  German 
Edition,  by  Norval  H.  Pierce,  M.D.,  Surgeon  to  the  Out-Door  Depart- 
ment of  Michael  Reese  Hospital;  Assistant  to  Surgical  Clinic,  College 
of  Pliysicians  and  Surgeons,  Chicago,  111. 

This  book  is  a  novelty  in  Bacteriological  Science.  It  is  arranged 
in  a  tabglar  form  in  which  are  given  the  specific  characteristics  of  the 
various  well-established  bacteria,  so  that  the  worker  may,  at  a  glance, 
inform  himself  as  to  the  identity  of  a  given  organism.  The}'  then  serve 
the  same  function  to  the  Bacteriologist  as  does  the  "  Chemical  Analysis 
Chart "  to  the  chemist,  and  the  oiie  will  be  found  as  essential  as  the 
other. 

The  Greatest  care  has  been  taken  to  bring  the  work  up  to  the 
present  aspect  of  Bacteriology. 

In  one  Octavo  volume,  handsomely  bound  in  Cloth.     Beady  Soon. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net;  in  Qreat 
Britain,  8s.  6d. ;  in  France,  9  fr.  35. 


EDIWGEM 

Twelve  Lectures  on  the  Structure  of  the 
Central  Nervous  System. 

For  Physicians  and  Students. 

By  Dr.  Ludwig  Edinger,  Frankfort-on-the-Main.  Second  Revised 
Edition.  With  133  Illustrations.  Translated  by  Willis  Hall  Vittum, 
M.D.,  St.  Paul,  Minn.  Edited  by  C.  Eugene  Biggs,  A.M.,  M.D.,  Pro- 
fessor of  Mental  and  Nervous  Diseases,  University  of  Minnesota; 
Member  of  the  American  Neurological  Association. 

The  illustrations  are  exactly  the  same  as  those  used  in  the  latest 
German  edition  (with  the  German  names  translated  into  English),  and 
are  very  satisfactory  to  the  Physician  and  Student  using  the  book. 

The  work  is  complete  in  one  Royal  Octavo  volume  of  about  250 
pages,  bound  in  Extra  Cloth. 

Price  in  United  States  and  Canada,  post-paid,  $1.75,  net ;  Great 
Britain,  10s. ;  France,  12  fr.  20. 

succeeded  in  transforming  the  mazy  wilder- 
ness of  nerve  fibres  and  cells  into  a  district  of 
well-marked  pathways  and  centres,  and  by  so 
doing  has  made  a  pleasure  out  of  an  anatomi- 
cal bugbear.— TÄe  Southern  Medical  Record. 

Every  point  is  clearly  dwelt  upon  in  the 
text,  and  where  description  alone  might  leave 
a  subject  obscure  clever  drawings  and  dia- 
grams are  introduced  to  render  inisconoeption 
of  the  author's  meaning  impossible.  The  book 
is  eminently  practical.  It  unravels  the  intri- 
cate entanglement  of  different  tracts  and 
paths  in  a  way  that  no  other  book  has  done  so 
explicitly  or  so  concisely. — Northwestern 
Lancet. 


One  of  the  most  instructive  and  valuable 
works  on  the  minute  anatomy  of  the  human 
brain  extant.  It  is  written  in  the  form  of  lec- 
tures, profusely  illustrated,  and  in  clear  lan- 
guage. The  book  is  worthy  of  the  highest 
enconiums,  and  will,  undoubtedly,  command  a 
large  sale.— 27ie  Pacific  Record  of  Medicine 
and  Surgery. 

Since  the  first  works  on  anatomy,  up  to  the 
present  day,  no  work  has  appeared  on  the  siib- 
]ect  of  the  general  and  minute  anatomy  of  the 
central  nervous  system  so  complete  and  ex- 
haustive as  this  work  of  Dr.  Ludwig  Edinger. 
Being  himself  an  original  worker,  and  having 
the  benefits  of  such  masters  as  Stilling, 
Weigeit,  Geilach,  Meynert,  and  others,  he  has 


(;8) 


Medical  PuhUcations  of  F.  A.  Davis,  Philadelphia. 
GOOnBLL 

Lessons  in  Gynecology. 

By  William  Goodell,  A.M.,  M.D.,  etc.,  Professor  of  Clinical  Gyne- 
cology in  the  TJniversit}'  of  Pennsylvania. 

This  exceeding]}'  valuable  work,  from  one  of  the  most  eminent 
specialists  and  teachers  in  gynecology-  in  the  United  States,  is  now 
offered  to  the  profession  in  a  much  more  complete  condition  than  eithef 
of  the  previous  editions.  It  embraces  all  the  more  important  diseases 
and  the  principal  operations  in  the  field  of  gynecology,  and  brings  to 
bear  upon  them  all  the  extensive  practical  experience  and  wide  reading 
of  the  author.  It  is  an  indispensable  guide  to  every  practitioner  who 
has  to  do  with  the  diseases  peculiar  to  women.  Third  Edition.  With 
112  illustrations.  Thoroughly  revised  and  greatl}'  enlarged.  One  volume, 
large  octavo,  578  pages. 

Price,  in  United  States  and  Canada,  Cloth,  $5.00;  Full  Sheep,  $6.00.    Discount, 

20  per  cent.,  making  it,  net.  Cloth,  $100;  Sheep,  $4.80.    Postage,  27 

cents  estra.     Great  Britain,  Cloth,  22s.  6d. ;  Sheep,  28s., 

post-paid.    France,  30  fr.  80. 


It  is  too  good  a  book  to  have  been  allowed  to 
remain  out  of  print,  ami  it  lias  unquostionably 
been  lni^se<l.  The  author  has  revised  the  work 
with  t-pecial  care,  adding  to  each  lesson  such 
fresh  matter  as  the  progress  in  the  art  ren- 
deied  necessary,  and  he  has  enlarp:ed  it  by  the 
insertion  of  six  new  lessons.  This  edition  will, 
without  question,  lie  a-s  eagerly  sought  for  as 
were  its  predecessors.— ^l»ie>-tca?)  Journal  of 
Obstetrics. 

His  literary  style  is  peculiarly  charming. 
There  is  a  directness  and  sinjplicity  about  it 
which  is  easier  to  admire  than  to  copy.  His 
chain  of  plain  words  and  almost  blunt  expres- 
sions, his  familiar  comparison  and  homely 
illustrations,  make  his  writings,  like  his  lec- 


tures, unusually  entertaining.  The  substance 
of  his  teachings  we  regard  as  equally  excel- 
lent.— Philadelphia  Medical  and  Surgical 
Reporter. 

Extended  mention  of  the  contents  of  the 
book  is  unnecessary;  suffice  it  to  say  that 
every  important  disease  fouml  in  the  female 
sex  IS  taken  up  and  discussed  in  a  common- 
sense  kind  of  a  way.  We  wish  every  physician 
in  America  could  "read  and  carry  out  the  sug- 
gestions of  the  chapter  on  "the  sexual  rela- 
tions a.s  causes  of  uterine  disorders — conjugal 
onanism  and  kindred  sins."  The  department 
treating  of  nervous  counterfeits  of  uterine 
diseases  is  a  most  valuable  ouc— Kansas  City 
Medical  Index. 


GUERNSEY 

Plain  Talks  on  Avoided  Subjects. 

By  Henry  X.  Guernsey,  M.D.,  formerly  Professor  of  Materia  Medici 
and  Institutes  in  the  Hahnemann  Medical  College  of  Philadi'Ii)hia ; 
author  of  Guernsey's  "  Obstetrics,"  including  the  Disorders  Peculiar  to 
Women  and  Young  Children  ;  Lectures  on  Materia  Mcdica,  etc.  The 
following  Table  of  Contents  shows  the  scope  of  tlie  book: 

Contents. — Cliapter  I.  Introductory.  II.  The  Infant.  III.  Child- 
hood. IV.  Adolescence  of  the  Male.  V.  Adolescence  of  the  Female. 
VI.  Marriage:  The  Husband.  VII.  The  Wife.  VIII.  Husband  and 
Wife.  IX.  To  the  Unfortunate.  X.  Origin  of  the  Sex.  In  one  neat 
IGmo  volume,  bound  in  Extra  Cloth. 

Price,  post-paid,  In  the  United  States  and  Canada,  $1.00 ;  Glreat  Britain, 

63. ;  France,  6  fr.  20. 

(») 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


HARJE 

Epilepsy:  Its  Pathology  and  Treatment. 

Being  an  Essay  to  which  was  Awarded  a  Prize  of  Four  Thousand 

Francs  by  the  Academie  Royale  de  Medecine  de  Belgique, 

December  31,  1889. 

By  HoBART  Amory  Hare,  M.D.  (Univ.  of  Penna.),  B.Sc,  Professor  of 
Materia  Medica  and  Therapeutics  in  tlie  Jefferson  Medical  College,  Phila.  ; 
Physician  to  St.  Agues'  Hospital  and  to  the  Children's  Dispensary  of  the  Chil- 
dren's Hospital ;  Laureate  of  the  Royal  Academy  of  Medicine  in  Belgium,  of 
the  Medical  Society  of  London,  etc.  ;  Member  of  the  Association  of  American 
Physicians. 

No.  7  in  the  Physicians'  and  Students'  Beady -Reference  Series.  13mo.  228 
pages.     Neatly  bound  in  Dark-blue  Cloth. 

Price,  post-paid,  in  TJnited  States  and  Canada,  $1.25,  net ;  in  Great 
Britain,  6s.  6d. ;  in  Prance,  7  fr.  75. 


It  is  representative  of  tlie  most  advanced 
views  of  the  profession,  and  tlie  subject  is 
pruned  of  the  vast  amount  of  superstition  and 
nonsense  that  generally  obtains  in  connection 
with  epilepsj'.— 3/edicäi  Age. 

Every  physician  who  would  get  at  the  gist 
of  all  that  IS  worth  knowing  on  epilepsy,  and 
who  would  avoid  useless  research  among  the 
mass  of  literary  nonsense  which  pervades  all 
medical  libraries,  should  get  this  work."— r^e 
Sanitarian. 

It  contains  all  that  is  known  of  the  pathology 
of  this  strange  disorder,  a  clear  discussion  of 
the  diagnosis  from  allied  neuroses,  and  the 
very  latest  therapeutic  measures  for  relief. 


It  is  remarkable  for  its  clearness,  brevity,  and 
beauty  of  style.  It  is,  so  far  as  the  reviewer 
knows,  altogether  the  best  essay  ever  written 
upon  this  important  subject.— .ff^ansas  City 
Medical  Index. 

The  task  of  preparing  the  work  must  have 
been  most  laborious,  but  we  think  that  Dr. 
Hare  will  be  repaid  for  his  efforts  by  a  wide 
appreciation  of  the  work  by  the  profession ; 
for  the  book  will  be  instructive  to  those  who 
have  not  kept  abrenst  with  the  recent  litera- 
ture upon  this  subject.  Indeed,  the  work  is  a 
sort  of  Dictionary  of  epilepsy— a  reference 
guide-book  upon  the  subject.— ^Wentsf  and 
JVeurologist. 


HABE 

Fever:  Its  Pathology  and  Treatment. 

Being  the  Boylston  Prize  Essay  of  Harvard  University  for  1890, 
Containing  Directions  and  the  Latest  Information  Con- 
cerning THE   Use  of   the   So-Called  Anti- 
pyretics IN  Fever  and  Pain. 

By  Hobart  Amory  Hare,  M.D.  (Univ.  of  Penna.),  B.Sc,  Professor  of 
Materia  Medica  and  Therapeutics  in  the  Jefferson  Medical  College,  Phila. ; 
Physician  to  St.  Agnes'  Hospital  and  to  the  Children's  Dispensary  of  the  Chil- 
dren's Hospital;  Laureate  of  the  Royal  Academy  of  Medicine  in  Belgium,  of  the 
Medical  Society  of  London,  etc.;  Member  of  the  Association  of  American 
Physicians. 

No.  10  in  the  Physicians'  and  Students'  Ready-Beference  Series.  12mo. 
Neatly  bound  in  Dark-blue  Cloth. 

Illustrated  with  more  than  25  new  plates  of  tracings  of  various  fever  cases, 
showing  beautifully  and  accurately  the  action  of  the  Antipyretics.  The  work 
also  contains  35  carefully  prepared  statistical  tables  of  249  cases  showing  the 
untoward  effects  of  the  antipyretics. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.25,  net;  in  Great  Britain, 
6s.  6d. ;  in  Prance,  7  fr.  75. 


As  is  usual  with  this  author,  the  subject  is 
thorouehly  handled,  and  much  experimental 
and  clinical  evidence,  both  from  the  author's 
experience  and  that  of  others,  is  adduced  in 
support  of  the  view  taken.— iV^ew;  York  Medical 
Abstract. 

The  author  has  done  an  able  piece  of  work 
in  showing  the  facts  as  far  as  they  are  known 
concerning  the  action  of  antipyrin,  anti- 
febrin,  phenacetin,  thallin,  and  salicylic  acid. 
The  reader  will  certaiidy  find  the  work  one  of 


the  moat  interesting  of  its  excellent  group, 
the  Physicians'  and  Students'  Readp-Iipfer- 
ence  Series.— The  Dosimetric  Medical  Review. 

Such  books  as  the  present  one  are  of  service 
to  the  student,  the  scientific  therapeutist,  and 
the  general  practitioner  alike,  for  much  can 
be  found  of  real  value  in  Dr.  Hare's  book,  with 
the  additional  advantage  that  it  is  up  to  the 
latest  researches  upon  the  subject.— i/mi^er- 
sity  Medical  Magazine, 


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Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
JA3IES 

American    Resorts,   with  Motes  upon  their  Cllmate. 

By  BüSHROD  W.  James,  A.M.,  M.D.,  Member  of  the  American  Public 
Health  Association,  and  the  Academy  of  Natural  Sciences,  Philadelphia;  the 
Society  of  Alaskan  Natural  History  and  Ethnoloacy,  Sitka,  Alaska,  etc.  With 
a  translation  from  the  German,  by  Mr.  S  Kauffmann,  of  those  chapters  of  "  Die 
Klimate  der  Erde"  written  by  Dr.  A.  Woeikof,  of  St  Petersburg,  Russia,  that 
relate  to  North  and  South  America  and  the  Islands  and  Oceans  contiguous  thereto. 

This  is  a  unique  and  valualile  work,  and  useful  to  physicians  in  all  parts  of 
the  country.  We  mention  a  few  of  the  merits  it  possesses:  First.  List  of 
all  the  Health  Resorts  of  the  country,  arranged  according  to  their  climate. 
Second.  Contains  just  the  information  needed  by'tourists,  invalids,  and  those  who 
visit  summer  or  winter  resorts.  Third.  The  latest  and  best  large  railroad  map  for 
reference.  Fourth.  It  indicates  the  climate  each  one  should  select  for  health. 
Fifth.  The  author  has  traveled  extensively,  and  most  of  his  suggestions  are 
practical  in  reference  to  localties.  In  one  Octavo  volume.  Handsomely  bound 
in  Cloth.     Nearly  300  pages. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net; 
Great  Britain,  lis.  6d. ;  Prance,  12  fr.  lO. 

Taken  altogetlier,   this  is  by  far  tlie  most  I]  pathological    indications    and   constitutional 
complete  expo.sition  of  the  subject  of  resorts  i  predispositions. — The  Sanitarian. 
that  ha.«  yet  been  put  forth,  ana  it  is  one  that  jl  The  book  before  ns  is  a  very  comprehensive 
every  physician  must  needs  possess  intelligent  ,i  volume,  giving  all  necessary  information  con- 
information  upon. -/?(f/ra?o  Jfert.d- iSw?-^.  Jomj".  j  cerning  climate,  temperntnre,  humidity,  sun- 

The  special  chapter  on  the  therapeutics  of  !  shine,  är.d  indeed  everything  necessary  to  be 

clin-ate    .    .    is  excellent  for  its  precautionary  \  stated   for  the    benetit  of    the  phy8i<ian    or 

suggestions  in  the  selection  of  climates  and  ■  invalid  seeking  a  health  resort  in  the  United 

local    conditions,    with    reference    to    known  ;  States. — Southern  Clinic. 


Journal  of  Laryngology  and  Rhinology. 

Issued  on  the  First  of  Each  Month. 

Edited  by  Dr.  Norris  Wolfenden,  of  London,  and  Dr.  John  Macintyre,  of 
Glasgow,  with  the  active  aid  and  co-operation  of  Drs.  Dundas  Grant,  Barclay  J. 
Baron,  Hunter  Mackenzie,  and  Sir  Morell  Mackenzie.  Besides  those  specialists 
in  Europe  and  America  who  have  so  ably  assisted  in  the  collaboration  of  the 
•Journal,  a  number  of  new  correspondents  have  undertaken  to  assist  the  editors  in 
keeping  the  .Journal  up  to  date,  and  furnishing  it  with  matters  of  interest. 
Amongst  these  are:  Drs.  Sajous,  of  Philadelphia;  Middlemass  Hunt,  of  Liver- 
pool; Mellow,  of  Rio  Janeiro;  Sedziak,  of  Warsaw;  Draispul,  of  St.  Petersburg, 
etc.  Drs.  ^Michael,  .Joal,  Ilolger,  ]\Iygind,  Prof  ]\Iassei,  and  Dr.  Valerius  Idelson 
will  still  collaborate  the  literature  of  their  respective  countries. 

Price,  13s.  or  $3.00  per  annum  (inclnsive  of  Postage).    For  single  copies,  however,  a 
charge  of  Is.  3i  (30  cents)  will  he  made.    Sample  Copy,  25  Cents. 


KBATING 

Record-Book  of  Medical  Examinations 

For  Life  Insurance. 

Designed  by  John  M.  Ki':atino,  M.D. 

This  record-book  is  small,  neat,  and  complete,  and  embraces  all  the  prin- 
cipal pf)inl8  that  are  re(iuired  by  the  different  companies.  It  is  made  in  two  sizes, 
viz.:  No.  1.  covering  one  hundred  (100)  e.xaniinations,  and  No.  2,  covering  two 
hundred  C200)  examinations.  The  size  of  the  bookis7.\.35  inches,  and  can  b« 
conveniently  carried  in  the  pocket. 

U.  S.  and  (^anada.  Great  Britain.      France. 

No.  1.    For  100  Ezaminations,  In  Cloth,    -    -    $  .50  Net  3s.  6d.         3  fr.  60 

No.  2.    For  200  Ezaminations,  in  Full 

Leather,  with  Side  Flap,    ....      1.00    "  6s.  6  it.  20 

(11) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


KJEATIJSra  and  EDWABDS 

Diseases  of  the  Heart  and  Circulation. 

In  Infancy  and  Adolescence.     With  an  Appendix  entitled  "  Clinical 
Studies  on  the  Pulse  in  Childhood." 

By  .John  M.  Keating,  M.D.,  Obstetrician  to  the  Pliiladelpliia  Hospital, 
and  Lecturer  on  Diseases  of  Women  and  Children;  Surgeon  to  the  Maternity 
Hospital;  Physician  to  St.  Joseph's  Hospital;  Fellow  of  the  College  of  Physicians 
of  Philadelphia,  etc.;  and  William  A.  Edwards,  M.D.,  Instructor  in  Clinical 
Medicine  and  Physician  to  the  Medical  Dispensary  in  the  University  of 
Pennsylvania;  Physician  to  St.  Joseph's  Hospital;  Fellow  of  the  College  of 
Physicians;  formerly  Assistant  Pathologist  to  the  Philadelphia  Hospital,  etc. 

Illustrated  by  Photographs  and  Wood-Engravings.  About  325  pages.  Oc- 
tavo.    Bound  in  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  6d.,'  in  France,  9  fr.  35. 


Drs.  Keating;  and  Edwards  have  produced  a 
work  that  will  give  material  aid  to  every 
doctor  in  his  practice  among  children.  The 
style  of  the  book  is  graphic  and  pleasing,  the 
diagnostic  points  are  explicit  and  exact,  and 
'the  therapeutical  resources  include  the  novel- 
ties of  medicine  as  well  as  the  old  and  tried 
agents. — Pittsburgh  Med.  Review. 


It  is  not  a  mere  compilation,  hut  a  systematic 
treatise,  and  bears  evidence  of  considerable 
labor  and  observation  on  the  part  of  the 
authors.  Two  fine  pliotographs  of  dissections 
exhibit  mitral  stenosis  and  mitral  regurgita- 
tion ;  there  are  also  a  number  of  wood-cuts. 
— Cleveland  Medical  Gazette. 


ZIJEBIG  and  MOMB 


Practical  Electricity  in  IVIedicine  ^  Surgery, 

By  G.  A.  LiEBiG,  Jr.,  Ph  D.,  Assistant  in  Electricity,  Johns  Hopkins 
University  ;  Lecturer  on  Medical  Electricity,  College  of  Physicians  and  Surgeons, 
Baltimore  ;  Member  of  the  American  Institute  of  Electrical  Engineers,  etc.  ;  and 
George  H.  Rohe,  M.D.,  Professor  of  Obstetrics  and  Hygiene,  College  of  Physi- 
cians and  Surgeons,  Baltimore  ;  Visiting  Physician  to  Bay  View  and  City  Hos- 
pitals ;  Director  of  the  Maryland  Maternite ;  Associate  Editor  "Annual  of  the 
Universal  Medical  Sciences,"  etc. 

Profusely  Illustrated  by  Wood-Engravings  and  Original  Diagrams,  and 
published  in  one  handsome  Royal  Octavo  volume  of  383  images,  bound  in  Extra 
Cloth. 

The  constantly  increasing  demand  for  this  work  attests  its  thorough  relia- 
bility and  its  popularity  with  the  profession,  and  points  to  the  fact  that  it  is 
already  the  standard  work  on  this  ver}^  important  subject.  The  part  on  Physical 
Electricity,  written  by  Dr.  Liebig,  one  of  the  recognized  authorities  on  the 
science  in  the  United  States,  treats  fully  such  topics  of  interest  as  Storage  Bat- 
teries, Dynamos,  the  Electric  Light,  and  the  Principles  and  Practice  of  Electrical 
Measurement  in  their  Relations  to  Medical  Practice.  Professor  Rohe,  who  writes 
on  Electro-Therapeutics,  discusses  at  length  the  recent  developments  of  Electricity 
in  the  treatment  of  stricture,  enlarged  prostate,  uterine  fibroids,  pelvic  cellulitis, 
and  other  diseases  of  the  male  and  female  genito-urinary  organs.  The  applica- 
tions of  Electricity  in  dermatology,  as  well  as  in  the  diseases  of  the  nervous 
system,  are  also  fully  considered. 

Price,  post-paid,  in  the  United  States  and  Canada,  $2.00,  net;  in  Great 
Britain,  lis.  6d. ;  France,  12  fr.  40. 

In  its  perusal,  with  each  succeeding  page, 
we  have  been  more  and  more  impressed  with 
the  fact  that  here,  at  last,  we  have  a  treatise 
on  electricity  in  medicine  and  surgery  which 
amply  fulfills  its  purpose,  and  which  is  sure  of 
general  adoption  by  reason  of  its  thorough 
excellence  and  superiority  to  other  works  in- 
tended to  cover  the  same  field. — Pharviaceu- 
tical  Era. 

After  carefully  looking  over  this  woi'k,  we 
incline  to  the  belief  that  the  intelligent  physi- 
cian who  is  familiar  with  the  general  subject 
will  be  greatly  interested  and  profited.  — 
American  Lancet. 


Any  physician,  especially  if  he  he  a  beginner 
in  electro-therapeutics,  will  be  well  repaid  by 
a  careful  study  of  this  work  by  Liebig  and 
Rohe.  For  a  work  on  a  special  subject  the 
price  is  low,  and  no  ene  can  give  a  good  ex- 
cuse for  remain. ng  in  ignorance  of  so  impor- 
tant a  subject  as  electricity  in  medicine. — 
Toledo  Medical  and  Surgical  Reporter. 

The  entire  work  is  thoroughly  scientific  and 
practical,  and  is  really  what  the  authors  have 
aimed  to  produce,  "  a  trustworthy  guide  to 
tile  application  of  electricitv  in  the  practice  of 
ijiedicine  and  Surgery."— iVeit'  York  Medical 
Times. 


(12) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


MASSEY 

Electricity  in  the  Diseases  of  Women. 

With   Special  Rkference  to  the   Application  of  Stronü  Currents, 

By  G.  Bettox  ;Massey.  ^I.D.,  Physician  to  the  Gynaecological  Department 
of  the  Howard  Hospital  ;  late  Electro-therapeutist  to  the  Philadeljjhia  Orthopaedic 
Hospital  and  Intjrmary  for  Nervous  Diseases  ;  Member  of  the  American  Neuro- 
logical Association,  of  the  Philadelphia  Neurological  Society,  of  the  Franklin 
Institute,  etc.  Second  Edition.  Revised  and  Enlarged.  With  New  and 
Original  Wood-Engravings.  Handsomely  bound  in  Dark-Bhie  Cloth.  240  pages. 
12nio.     Xo.  5  ill  the  Physkidns'  and  Students'  Ready-Rcferenee  Series. 

This  work  is  presented  to  the  profession  as  the  most  complete  treatise  j^et 
issued  on  the  electrical  treatment  of  the  diseases  of  women,  and  is  destined  to 
till  the  increasing  demand  for  clear  and  practical  instruction  in  the  handling  and 
use  of  strong  currents  after  the  recent  methods  first  advocated  by  Apostoli.  The 
whole  subject  is  treated  from  the  present  stand-point  of  electric  science  with  new 
and  original  illustrntions,  the  thorough  studies  of  the  author  and  his  wide  clinical 
experience  rendering  him  an  authority  upon  electricity  itself  and  its  tlierapeutic 
applications.  The. author  has  enhanced  the  practical  value  of  the  work  by 
including  the  exact  details  of  treatment  and  results  in  a  number  of  cases  taken  from 
his  private  and  hospital  practice. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net ;  in  Grreat 
Britain,  8s.  6d. ;  in  France,  9  fr.  35. 


A  new  edition  of  this  practical  manual  at- 
tests the  utility  of  its  existence  and  the  recog- 
nition of  its  merit.  The  <l)rections  are  simple, 
e:isy  to  follow  and  to  put  into  practice  ;  the 
irronndiswell  covered,  and  nothing  is  assumed, 
the  entire  book  beingthe  record  of  experience. 
— Journal  of  Xeit'otis  (tnd  MftiUal  Diseases. 

It  is  only  a  few  months  since  we  noticed  the 
first  edition  of  this  little  book;  and  it  is  only 
nece.ssary  to  add  now  that  we  consider  it  the 
best  treatise  on  this  subject  we  have  seen,  and 


that  the  improvements  introduced  into  th's 
edition  make  it  more  valuable  still. — Boston 
Medical  and  Surgical  Journ. 

The  style  is  clear,  but  condensed.  Useless 
detaile  arc  omitted,  the  reports  of  cases  being 
pruned  of  all  irrelevant  material.  The  book 
IS  an  exceedingly  valuable  one.  and  represents 
an  amount  of  study  and  experience  which  is 
only  appieciated  after  a  careful  reading. — 
Medical  Record. 


IIAWTOJ^ 

Childbed;  Its  Management;  Diseases  and 
Tlieir  Treatment. 

By  Wai-tkk  p.  >r.\NTON,  M.D.,  Visiting  Physician  to  the  Detroit  Woman's 
Hospital  ;  Consulting  Gynfccologist  to  the  Eastern  Michigan  Asylum  ;  President 
of  the  Detroit  Gynaecological  Society  ;  Fellow  of  the  American  Societ}'  of  Ob- 
stetricians and  Gyna3cologiRts,  and  of  the  British  Gynnecological  Society  ;  Member 
of  Michigan  State  Medical  Society,  etc.  In  one  neat  12mo  volume,  iVb.  in 
the  Physicians'  and  Students'  Ready- Reference  Series.     In  Prep.au.\tion. 


Medical  Bulletin. 

A  Monthly  Joirnal  of  Medicine  and  Surgery. 

Edited  by  John  V.  Shoemaker.  A.M.,  M.D.  Bright,  original,  and  read- 
able. Articles  by  llie  Ix^st  practical  writers  procural)le.  Every  arlicle  as  brief  a» 
is  consistent  with  the  preservation  of  its  scientific  value.  Thera])eutic  Notes  by 
tiie  leaderij  of  liie  medical  profession  throughout  tlu;  world.  ,  These,  and  nuiny 
other  unif^ue  features,  ludp  to  kee])  'I'lir,  Mkdicai.  Bui,i-etin  in  its  lucscnt 
position  as  tlie  leading  low-price  .Medicnl  .Monthly  of  the-  world.     Subscribe  now. 

TEEMS :  $1.00  a  year  in  advance  in  United  States,  Canada,  and  Mesico. 
Foreign  Subscription  Terms :  England,  5s. ;  France,  6  fr. ;  Germany, 
6  marks;  Japan,  1  yen;  Australia,  5s.;  Holland,  3  florins. 

(13) 


Medical  Puhlications  of  F.  A.  Davis,  Philadelphia. 


The  Medical  Bulletin  Visiting-List  or 
Physicians'  Call  Record. 

Arranged  upon  an  Original  and  Convenient  Monthly  and  Weekly 
Plan  for  the  Daily  Recording  op  Professional  Visits. 


Frequent  Rewriting  of  Names  Unnecessary. 

THIS  Visiting-List  is  arranged  so  that  the  names  of  patients  need  be  written 
but  ONCE  a  month  instead  of  four  times  a  month,  as  in  the  old-style  lists. 
By  means  of  a  new  feature,  a  simple  device  consisting  of  stub  or  half 
LEAVES  IN  THE  FORM  OF  INSERTS,  the  first  Week's  visits  are  recorded  in  the  usual 
way,  and  the  second  week's  visits  are  begun  by  simply  turning  over  the  half-leaf 
without  the  necessitj''  of  rewriting  the  patients'  names.  This  very  easily  under- 
stood process  is  repeated  until  the  month  is  ended  and  the  record  has  been  kept 
complete  in  every  detail  of  visit,  charge,  credit,  etc.,  and  the  labor  and  time 
of  entering  and  ti-ansferring  names  at  least  three  times  in  the  month  has  been 
saved.  There  are  no  intricate  rulings  ;  not  the  least  amount  of  time  can  be  lost 
in  comprehending  the  plan,  for  it  is  acquired  at  a  glance. 

THE  THREE  DIFFERENT  STYLES  MADE. 

The  No.  1  Style  of  this  List  provides  space  for  the  daily  record  of  seventy 
different  names  each  month  for  a  year  ;  for  physicians  who  prefer  a  List  that  will 
accommodate  a  larger  practice  we  have  made  a  No.  2  Style,  which  provides 
space  for  the  daily  record  of  lOö  different  names  each  month  for  a  year,  and  for 
physicians  who  may  prefer  a  Pocket  Record-Book  of  less  thickness  than  either  of 
these  styles  we  have  made  a  No.  3  Style,  in  which  "The  Blanks  for  the  Record- 
ing of  Visits  in  "  have  been  made  into  removable  sections.  These  sections  are 
very  thin,  and  are  made  up  so  as  to  answer  in  full  the  demand  of  the  largest 
practice,  each  section  providing  ample  space  for  the  daily  record  of  210  dif- 
ferent NAMES  for  two  months  ;  or  105  different  names  daily  each  month  for  four 
months ;  or  seventy  different  names  daily  each  month  for  six  mouths.  Six  sets 
of  these  sections  go  with  each  copy  of  No.  3  Style. 

SPECIAL  FEATURES  NOT  FOUND  IN  ANY  OTHER  LIST. 

In  this  No.  3  Style  the  printed  matter,  and  such  matter  as  the  blank 
FORMS  FOR  Addresses  of  Patients,  Obstetric  Record,  Vaccination  Record, 
Cash  Account,  Birth  and  Death  Records,  etc.,  are  fastened  permanently  in  the 
back  of  the  book,  thus  reducing  its  thickness.  The  addition  of  one  of  these 
removable  sections  does  not  increase  the  thickness  more  than  an  eighth  of  an  inch. 
This  brings  the  book  into  such  a  small  compass  that  no  one  can  object  to  it  on 
account  of  its  thickness,  as  its  bulk  is  very  much  less  than  that  of  any  visiting- 
list  ever  published.  Every  physician  will  at  once  understand  that  as  soon  as  a 
section  is  full  it  can  be  taken  out,  tiled  away,  and  another  inserted  without  the 
least  inconvenience  or  trouble.  Extra  or  additional  sections  will  1)6  furnislied  at 
any  time  for  15  cents  each  or  ^1.75  per  dozen.  This  Visiting-List  contains  calen- 
dars, valuable  miscellaneous  data,  important  tables,  and  other  useful  printed 
matter  usually  placed  in  Physicians'  Visiting-Lists. 

Physicians  of  many  years'  standing  and  with  large  practices  pronounce  it 
THE  Best  List  they  have  ever  seen.  It  is  liandsomely  bound  in  fine,  strong 
leather,  with  flan,  including  a  pocket  for  loose  memoranda,  etc.,  and  is  furnished 
with  a  Dixon  lead-pencil  of  excellent  quality  and  finish.  It  is  compact  and  con- 
venient for  carrying  in  the  pocket.     Size,  4x6|-  inches. 

* 

I2>T    TE3:r2.ElEX    ST"!rLE:S-  net   prices. 

No.  1.     Regular  size,  to  accommodate  70  patients  daily  each  month  for  one  year,    .     .     .     S1.25 

No.  3.     Large  size,  to  accommodate  105  patients  daily  each  month  for  one  year,  ....     SSI. 50 

No.  3.     In  which  the  "  Blanks  for  Recording  Visits  in  "  are  in  removable  sections,  .     .     .     SI. 75 

Special  Edition  for  Great  Britain,  without  printed  matter,        4s.  6d. 

N.  B, — The  Recording  of  Visits  in  this  List  may  be  Commerced  at  any  time  during  the  Year, 

(14) 


Medical  Pahlications  of  F.  A.  Davis,  Philadelphia. 


Hand-Book  of  Eclampsia ; 


OR,    JUOXES    AIV»    CASES 

OF"    PVERPERAI^ 

CO^SVILSIONS. 

By  E.  MiCHENER,  M.D.  ;  J.  H.  Stubbs,  M.D.  ;  R.  B.  Ewing,  M.D.  ;  B. 
Thompson,  M.D.  ;  S.  Stebbins,  M.D.     16ino.     Cloth. 

Price,  60  cents,  net ;  in  Great  Britain,  4s.  6d. ;  France,  i  ft.  20. 


JSriSSEN 
A  MANUAL  OF  INSTRUCTION   FOR   GIVING 

Swedish  Movement  ^  Massage  Treatment 

By  Prop.  H.\rtvig  Nissen,  late  Director  of  the  Swedish  Ilcalth  Institute, 
WasliinETton,  D.  C.  ;  late  Instructor  in  Physical  Culture  and  Gymnastics  at  the 
Johns  Hoj»kins  University,  Baltimore,  Md.  ;  Instructor  of  Swedish  and  German 
Gymnastics  at  Harvard  University's  Summer  School,  1891. 

This  excellent  little  volume  treats  this  very  important  subject  in  a  practical 
manner.  Full  instructions  are  given  regarding  the  mode  of  applying  the  Swedish 
Movement  and  Massage  Treatment  in  various  diseases  and  conditions  of  the 
human  system  witli  the  greatest  degree  of  effectiveness.  Professor  Nissen  is  the 
best  authority  in  the  United  States  upon  the  practical  phase  of  this  subject,  and 
his  book  is  indisjiensable  to  every  physician  who  wishes  to  know  how  to  use  these 
valuable  handmaids  of  medicine. 

Illustrated  with  29  Original  Wood-Engravings.  In  one  12mo  volume  of 
128  Pages.     Neatly  bound  in  Cloth. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net; 
Great  Britain,  6s. ;  France,  6  fr.  20. 


This  niariiial  is  valuat)le  to  the  practitioner, 
a.s  it  contains  a  terse  description  of  a  subject 
Imt  too  little  understood  in  this  country.  .  . 
The  l)0()k  is  got  up  very  creditably. — N.  Y. 
Med.  Jour. 

The  present  volume  is  a  modest  account  of 
the  apv>lication  of  the  Swedish  .Movement  and 
Massage  Treatment,  in  which  the  technique  of 


the  various  procedures  are  clearly  stated  as 
well  as  illustrated  in  a  very  excellent  manner. 
—North  American  Practitioner. 

This  attractive  little  book  presents  the  sub- 
ject in  a  very  practical  shape,  and  makes  it 
possible  for  every  physician  to  understand  at 
least  how  it  is  applied,  if  it  does  not  g  ve  liim 
dexterity  in  the  art  of  its  application. — Chicago 
Med.  limes. 


Physicians'  Interpreter. 

In  Four  Languages  (English,  French,  German,  and  Italian). 
Specially  Arranged  for  Diagnosis  by  M.  von  V. 

The  object  of  this  little  work  is  to  meet  a  need  often  keenly  felt  by  the  busy 
physician,  namely,  the  need  of  some  quick  and  reliable  method  of  communicating 
intellitrildy  with'patients  of  those  nationalities  and  languages  unfamiliar  to  the 
practitioner.  The  plan  of  the  book  is  a  systematic  arrangement  of  questions 
upon  the  various  branches  of  Practical  Medicine,  and  each  question  is  so  worded 
that  the  only  answer  required  of  the  patient  is  merely  Yes  or  No.  The  cpu^stions 
are  all  numbered,  and  a  complete  Inde,\  renders  them  always  available  for  quick 
reference.  The  book  is  written  by  one  who  is  well  versed  in  Engiisli,  French, 
German,  and  Italian,  being  an  excellent  teacher  in  all  those  languages,  and  who 
has  also  had  considerable  hosi)ital  experience.  Bound  in  Full  Russia  Leather, 
for  carrying  in  tlie  pocket.     Size,  5x23  inches.     206  pages. 

Frise,  post-paid,  in  united  States  and  Canada,  q>1.00,  net ;  Great 
Britain,  6s. ;  Prance,  6  fr.  20. 


Many  other  books  of  the  same  sort,  with 
more  extensive  vocabularies,  have  been  p\ib- 
lishr-d,  Imt.  from  their  size,  and  from  their 
l)einK  usually  devoterl  tr)  cquivalantfl  in  Knp:- 
rwli  and  (me  other  laiißuaKe  only,  they  have 
not  bail  the  advantajre  which  is  pre-eminent 
in  tili»— eonvenleriee.  It  is  hand'^omely  printed, 
and  liounrl  in  flexible  red  leather  intlie  form 
of  a  diary.  It  would  scarcely  make  itsiOf  fc^lt 
In    one's    hip-pocket,    and    would    insure    its 


liearcr  against   any   ordinary  conversational   ||   Courier  of  Medicine, 

(15) 


difficulty  in  dealing  with  foreign-speaking 
jK-ople.  who  aie  constantly  cnniing  into  our 
city  hospitals.— iV^'w  York  Medical  Journal. 

This  little  volume  Is  one  of  the  most  inge- 
nious aids  Ir)  the  i)hysician  which  we  have 
seen.  We  hi'artily  loiiimend  tin;  book  to  any 
one  who,  IxMiig  without  a  knowleilge  of  the 
foreign  languagi'S,  is  obliged  to  treat  tliose 
who  do  not  know  our  own  language. — SI.  Louii 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


ician's  All-Requisite  Time-  and  Labor- 
Saying  Account-Book. 

Being  a   Ledger   and  Account-Book  for   Physicians'   Use,  Meeting 
ALL  THE  Requirements  of  the  Law  and  Courts. 

Design ed  by  William  A.  Seibert,  M.D  ,  of  Easton,  Pa. 

Probably  no  class  of  people  lose  more  money  through  carelessly  kept 
accounts  and  overlooked  or  neglected  bills  than  physicians.  Often  detained  at 
the  bedside  of  the  sick  until  late  at  night,  or  deprived  of  even  a  modicum  of  rest, 
it  is  with  great  difficulty  that  he  spares  the  time  or  puts  himself  in  condition  to 
give  the  same  care  to  his  own  financial  interests  that  a  merchant,  a  lawyer,  or 
even  a  farmer  devotes.  It  is  then  plainly  apparent  that  a  system  of  bookkeeping 
and  accounts  that,  without  sacrificing  accuracy,  but,  on  the  other  hand,  ensuring 
it,  at  the  same  time  relieves  the  keeping  of  a  physician's  book  of  half  their 
complexity  and  two-thirds  the  labor,  is  a  convenience  which  will  be  eagerly 
welcomed  by  thousands  of  overworked  physicians.  Such  a  system  has  at  last 
been  devised,  and  we  take  pleasure  in  ofi'eriug  it  to  the  profession  in  the  form  of 
The  Physician's  All-Requisite  Time-  and  Labor-  Saving  Account-Book. 

There  is  no  exaggeration  in  stating  that  this  Account-Book  and  Ledger 
reduces  the  labor  of  keeping  your  accounts  more  than  one -half,  and  at  the  same 
time  secures  the  greatest  degree  of  accuracy.  We  may  mention  a  few  of  the 
superior  advantages  of  The  Physician's  All-Requisite  Time-  and  Labor-  Saving 
Account-Book,  as  follows  : — 


First — Will  meet  all  the  requirements 
of  the  law  and  courts. 

Second — Self-explanatory  ;  no  cipher 
code. 

Third — Its  completeness  without  sacri- 
ficing anything. 

Fourth — No  posting  ;  one  entry  only. 

Fifth — Universal ;  can  be  commenced  at 
any  time  of  the  year,  and  can  be 
continued  indefinitely  until  every 
account  is  filled. 

Sixth — Absolutely  no  waste  of  space. 

Seventh — One  person  must  needs  be 
sick  every  day  of  the  year  to  fill 
his  account,  or  might  be  ten  years 
about  it  and  require  no  more  than 
the  space  for  one  account  in  this 
ledger. 

Eighth — Double  the  number  and  many 
times  more  than  the  number  of  ac- 


counts in  any  similar  book  ;  the 
300-page  book  contains  space  for 
900  accounts,  and  the  600-page 
book  contains  space  for  1800  ac- 
counts. 

/ninth — There  are  no  smaller  spaces. 

Tenth — Compact  without  sacrificing 
completeness  ;  every  account  com- 
plete on  same  page — a  decided  ad- 
vantage and  recommendation. 

Eleventh — tlniform  size  of  leaves. 

Twelfth — The  statement  of  the  most 
complicated  account  is  at  once  be- 
fore you  at  any  time  of  month  or 
year — in  other  words,  the  account 
itself  as  it  stands  is  its  simplest 
statement. 

Thirteenth — No  transferring  of  accounts, 
balances,  etc. 


To  all  physicians  desiring  a  quick,  accurate,  and  comprehensive  method  of- 
keeping  their  accounts,  we  can  safely  say  that  no  book  as  suitable  as  this  one  has 
ever  been  devised.  A  descriptive  circular  showing  the  plan  of  the  book  will  be 
sent  on  application. 


NET  PRICES,  SHIPPING  EXPENSES  PREPAID. 

D.  1.  300  Pages,  for  900  Accounts  per  Year,  Canada 

Size  IO2I2,  Bound  in  K-Eussia,  Raised  inu.s.  (duty  paid). 

Back-Bands,  Cloth  Sides,        .       .       .    $5.00  $5.50 
fe  ?.  600  Pages,  for  1800  Accounts  per  Year, 

^ize  10sl2,  Bound  in  K -Russia,  Raised 

^k-Bands,  Cloth  Sides,               .       . '    8.00  8.80 

(16) 


Great 
Britain. 

28s. 


France. 

30  fr.  30 


42s.         49  fr.  40 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


PBICE  and  BAGLETON 

Three  Charts  of  the  Nervo-Uascular  System. 

Part  I. — The  Nerves.      Part  II. — The  Arteries. 
Part  III. — The  Veins. 

A  Xew  Edition,  Revised  and  Perfected.  Arranged  hy  W.  Henry  Pinn:, 
M.D.,  and  S.  Potts  Eagleton,  M.D.  Endorsed  by  leading  uuutouiists.  Clearly 
and  beautifully  printed  upon  extra  durable  paper. 

PART  I.  The  Nerves. — Gives  in  a  dear  form  not  only  tlie  Cranial  and  Spinal  Nerves,  show- 
ing the  formation  ot  the  tlitt'eiend  Plexuses  and  their  branches,  but  also  the  complete 
distribution  of  the  Sympathetic  Nerves. 

PAKT  II.  The  Arteries — (jives  a  unique  grouping  of  the  Arterial  system,  showing  the 
divisions  and  subdivisions  of  all  the  vessels,  beginning  from  the  heart  and  trafing  their 
COXTINUOUS  distribution  to  the  periphery,  and  showing  at  a  glance  the  terminal 
branches  of  each  artery. 

PART  III.  The  Veins — Shows  how  the  blood  from  the  periphery  of  the  body  is  gradually 
collected  by  the  larger  veins,  and  these  coalescing  forming  still  larger  vessels,  until  they 
finally  trace  themselves  into  the  Hight  Auricle  of  the  heart. 

It  is  therefore  readily  seen  that  "The  Nervo-Vascular  System  of  Charts'" 
offers  the  following  superior  advantages  : — 

1.  It  is  the  only  arrangement  which  combines  the  Three  Systems,  and  yet 
each  is  perfect  and  distinct  in  itself 

2.  It  is  the  only  instance  of  the  Cranial,  Spinal,  and  Sympathetic  Nervous 
Systems  being  represented  on  one  chart. 

3.  From  its  neat  size  and  clear  type,  and  being  printed  only  upon  one  side, 
it  may  be  tacked  up  in  any  convenient  place,  and  is  always  ready  for  freshening 
up  the  memory  and  reviewing  for  examination. 

Price,  post-paid,  in  United  States  and  Canada,  50  cents,  net,  complete ;  in 
Great  Britain,  3s.  6d. ;  in  France,  3  fr.  50. 


For  the  student  of  anatomy  there  can  pos- 
sibly be  no  more  concise  way  of  acquiring  a 
knowledge  of  the  nerves,  veins,  and  arteries 
of  the  human  system.  It  presents  at  a  glance 
their  trunks  and  branches  in  the  great  divis- 
ions of  tlie  body.  It  will  save  a  world  of  tedi- 
ous reading,  and  will  impress  itself  on  the 
mind  as  no  ordinary  vade  viecum,  even,  could. 


Its  price  is  nominal  and  its  value  inestimable. 
No  student  shovilil  be  without  it. — Pacific 
Record  of  Medicine  and  Surgery. 

These  are  three  admirably  arranged  charts 
for  the  use  of  students,  to  assist  in  memor- 
izing their  anatomical  sudies. — Buffalo  Med. 
and  Surg.  Jour. 


JPUBDY 

Diabetes:  Its  Cause, Symptoms  anl^ Treatment 

By  Chas.  W.  Purdy,  M.D.  (Queen's  University),  Honorary  Fellow  of  the 
Royal  College  of  Pliysicians  and  Surgeons  of  Kingston  ;  Member  of  the  College 
of  Physicians  and  Surgeons  of  Ontario  ;  Author  of  "Blight's  Disease  and  Allied 
AflFection.s  of  the  Kidneys  ;."  Member  of  the  Association  of  American  Physicians  ; 
Member  of  the  American  Medical  Association  ;  Member  of  the  Chicago  Academy 
of  Sciences,  etc. 

CoNTKNTs. — Section  I.  Historical,  Geographical,  and  Climatological  Con- 
Biderations  of  Diabetes  Mellitus.  II.  Pliysiological  and  Pathological  Considera- 
tions of  Diabetes  Mellitus  III.  Etiology  of  Diabetes  Mellitus.  IV.  IMorbid 
Anatomy  of  Diabetes  Mellitus.  V.  Symptomatology  of  Diabetes  Mellitus.  VI. 
Treatment  of  Diabetes  .Mellitus.  VII.  C;iinical  Illustrations  of  Diabetes  Mellitus. 
VIII.  Diabetes  Insipidus  ;  Bibliography. 

12uio.  Dark  Blue  Extra  Clotli.  Nearly  200  pages.  AVith  Clinical  Illus- 
trations.    No.  S  in  the  PhynHam''  and  Student»'  Ready -lief crence  Series. 

Price,  post-paid,  in  the  united  States  and  Canada,  $1.25,  net;  in  Great 
Britain,  6s.  6d. ;  in  France,  7  fr.  75. 


T)ii-  will  prove  a  most  entertaining  as  well 
a»  most  JntrTCHting  treatise  upon  a  disease 
which  frefjnetitly  falls  to  the  lr)t  r)f  every 
jiractitloni-r.  The  work  has  been  written  with 
a  Hpecial  view  of  bringing  ont  the  fi-atuies  of 
the  diHea><oaHit  oci.iirs  in  the  ITnited  States. 
The  author  ha»  verv  judiciously  arrang(Ml  the 
liitlc  v'llnnie.  and  it  *vill  offer  many  moasant 
attractions  to  the  iiractitioiicr. — JVanhviUe 
Journiil  of  Medicine  and  Surgery. 

Wbile  many  luonugraphH  Lave  been  pab- 


lished  which  have  dealt  with  the  snb.icct  of 
diabetes,  we  know  of  none  which  so  ilioroiighly 
considers  its  relations  to  the  geographical 
conditions  which  (!xist  in  the  United  Slates. 
nor  which  is  more  complete  in  its  snnimary  of 
the  symptomatology  and  treatment  of  this 
aH'ect'ion.  A  number  of  tables,  showing  the 
percentage f>f  sngar  in  a  very  large  number  of 
alcoholic  lieverages,  adils  very  consideralily  to 
the  value  of  the  work.— iWetZtcai  News. 


(17) 


Medical  Publications  of  F.  A.  Davis^  Philadelphia. 


MEMOJ^DINO 


S 


Operation,  Etc. 


From  the  Earliest  Times  to  the  Present;  with  a  History  of 
Eunuchism,  Hermaphrodism,  etc.,  as  Observed  Among  all  Races 
AND  Nations;  also  a  Description  of  the  Different  Operative 
Methods  of  Modern  Surgery  Practiced  upon  the  Prepuce. 

By  P.  C.  Remondino,  M.D.  (Jefferson)  ;  Member  of  the  American  Medical 
Association;  Member  of  the  American  Public  Health  Association;  Vice-President 
of  the  State  Medical  Society  of  California,  and  of  the  Southern  California  Medical 
Society,  etc.,  etc. 

JYo.  11  in  the  Physicinns'  and  Students'  Ready -Reference  Berks.  About  350 
pages.     12mo.     Handsomely  bound  in  Dark-Blue  Cloth.     Just  Ready. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.25,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  7  fr.  75.  Cheap  Edition  (paper  hinding), 
united  States  and  Canada,  50  cents,  net,  post-paid;  Great  Britain, 
^s.  3d. ;  France,  i  fr,  20. 


ROHE 

Text-Book  of  Hygiene. 

A  Comprehensive  Treatise  on  the  Principles  and  Practice  op  Pre- 
ventive Medicine  from  an  American  Standpoint. 

By  George  H.  Rohe,  M.D.,  Professor  of  Obstetrics  and  Hygiene  in  the 
College  of  Physicians  and  Surgeons,  Baltimore  ;  Member  of  the  American  Public 
Health  Association,  etc. 

Every  Sanitarian  should  have  Robe's  "  Text-Book  of  Hygiene  "  as  a  work 
of  reference.  Of  this  New  (second)  edition,  one  of  the  best  qualified  judges, 
namely,  Albert  L.  Gihon,  M.D.,  Medical  Director,  U.  S.  Navy,  in  charge  of  U.  S, 
Naval  Hospital,  Brooklyn,  N.  Y..  and  ex-President  of  the  American  Public 
Health  Association,  writes  :  "It  is  the  most  admirable,  conc\&&  resume  of  the  facts 
of  Hygiene  with  which  I  am  acquainted.  Prof  Robe's  attractive  style  makes 
the  book  so  readable  that  no  better  presentation  of  the  important  place  of  Pre- 
ventive Medicine,  among  their  studies,  can  be  desired  for  the  younger  members, 
especially,  of  our  profession. 

Second  Edition,  thoroughly  revised  and  largely  rewritten,  with  many 
illustrations  and  valuable  tables.  In  one  handsome  Royal  Octavo  volume  of 
over  400  pages,  bound  iu  Extra  Cloth. 

Price,  post-paid,  in  United  States,  $2.50,  net ;  Canada  (duty  paid),  $2.75, 
net ;  Great  Britain,  14s. ;  France,  16  fr.  20. 


In  short,  the  work  contains  brief  and  prac- 
tical articles  on  hygienic  regulation  of  life, 
under  almost  all  conditions  One  prominent 
feature  is  that  there  are  no  superfluous  words  ; 
every  sentence  is  direct  to  the  point  sought. 
It  is,  therefore,  easy  reading,  and  convevs  very 
much  Information  in  little  space. — Ttie  Pacific 
Record  of  Medicine  and  Surgery. 

Truly  a  most  excellent  and  valuable  work, 
comprising  the  accepted  facts  in  regard  to 
preventive  medicine,  clearly  stated  and  well 
arranged.  It  is  unquestionably  a  work  that 
should  be  in  the  hands  of  every  physician  in 
the  country,  and  medical  students  will  find  it 
a  most  excellent  and  valuable  text-book. — The 
Southern  Practitioner. 

The  first  edition  was  rapidly  exhausted,  and 
the  book  justly  became  an  authority  to  physi- 
cians and  sanitary  officers,  and  a  text-book  very 
generally  adopted  in  the  colleges  throughout 
Araerica.  The  second  edition  is  a  great  improve- 
m^it  over  the  first,  all  of  the  matter  being  thor- 


oughly revised,  much  of  it  being  rewritten, 
and  manv  additions  being  made.  The  size  of 
the  book  is  increased  one  hundred  pages. 
The  book  has  the  original  recommendation  of 
being  a  handsomely-bound,  clearly-printed 
octavo  volume,  profusely  illustrated  with  re- 
liable references  for  every  branch  of  the 
subject  matter.— Afedieal  Record. 

The  wonder  is  how  Prof.  Rohe  has  made  the 
book  so  readable  and  entertaining  with  so 
much  matter  necessarily  condensed.  The 
book  is  well  printed  with  good,  clear  type,  is 
attractive  in  appearance,  and  contains  a 
number  of  valuable  tables  and  illustration» 
that  must  be  of  decided  aid  to  the  student,  if 
not  to  the  general  practitioner  and  health 
officer.  Altogether,  the  manual  is  a  good  ex- 
ponent of  hygiene  and  sanitary  science  from 
the  present  American  Stand-point,  and  will 
repay  with  pleasure  and  profit  any  time  that 
may  be  given  to  its  -per-xis^X.— University  Medv- 
cal  Magazine. 


(18) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


HAY  FEVER 


SAJO  US 

And  Its  Successful   Treatment  by  Superficial 

Organic   Alteration    of  tbe   Kasal 

9IUCOUS     Membrane. 


Bj'  Charles  E.  Sajous,  ]\LD.,  former]}^  Lecturer  on  Rliinology  and 
Laryngology  in  Jefferson  Medical  College;  Vice-President  of  the  American 
Larj-ngological  Association;  Officer  of  the  Academy  of  France  and  of  Public 
Instruction  of  Venezuela  ;  Corresponding  Member  of  the  Royal  Society  of 
Belgium,  of  the  Medical  Society  of  Warsaw  (Poland),  and  of  the  Society  of 
Hygiene  of  France;  Member  of  the  American  Philosophical  Society,  etc.,  etc. 

With  13  Engravings  on  Wood.  103  pages.  12mo.  Bound  in  Cloth. 
Beveled  Edges. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net;  in  Great 
Britain,  6s.;  France,  6  fr.  20. 


SAJS'NE 

Däphtherlä,  Croup:  Tracheotomy  and 
Intubation. 

From  the  French  of  A.  SannI 

Translated  and  enlarged  hy  Henry  Z.  Gill,  M  D.,  LL.D.,  late  Pro- 
fessor of  Surgery  in  Cleveland,  Ohio. 

Sanne's  work  is  quoted,  directly  or  indirectly,  l)y  eveiy  Avriter  since 
its  puhlictition,  as  the  hi<;iicst  authority,  statistically,  theoietically.  and 
practically.  The  translator,  having  given  special  study  to  the  subject 
for  many  years,  has  added  over  liity  i)ages,  including  the  Surgical 
Anatomy,  lutidjation,  and  the  recent  progress  in  other  branches,  making 
it,  beyond  question,  the  most  complete  work  extant  on  the  subject  of 
Dii)htheria  in  the  English  language. 

Facing  the  title-i)age  is  found  a  very  fine  Colored  Lithograph  Plate 
of  the  parts  concerned  in  Tracheotomy.  Next  follows  an  illustration 
of  a  cast  of  the  entire  Trachea,  and  bronclii  to  the  third  or  fourth 
division,  in  one  piece,  taken  from  a  photograph  of  a  case  in  which  the 
east  was  expelled  during  life  from  a  patient  sixteen  years  old.  This  is 
the  most  complete  cast  of  any  one  recorded. 

Over  fifty  other  illustrations  of  the  surgical  anatomy  of  instruments, 
etc.,  add  to  tlie  practical  value  of  the  work. 

A  full  Index  accompanies  the  enlarged  v<)lume,  also  a  Tjist  of 
Authf)rs,  making  altogether  a  very  Inuulsome  illustrated  volume  of 
over  680  pages. 

Canad.T 
United  States.       (duty  paid).     Great  Britain.       France. 


Price,  post-paid,  Cloth,   -    $4.00,  Net     $140,  Net 
Leather,      5.00,  "         5.50,  " 


22s.  6d.      24  fr.  60 
28s.  30  fr.  30 


Tlie  Riilijfct  of  intubation,  no  recently  ro- 
vlve<l  in  thf«  C'luntrv,  rcnelvas  a  very  care- 
ful and  impartial  dlHCUMHlon  at  the  hands 
of  tlic  translator,  and  a  rn'mt  valiialilc  nh.ai)ter 
on  the  pro])livlaxiH  of  diphtheria  and  croup 
dopes  the  volume.  Altosruther  the  hook  is 
one  that  Is  vrilnahle  an«l  tinndy,  and  one  that 
Hbould  be  in  the  hands  of  every  general  prac- 


titioner.—W.  Lonin  Med.  and  Surr/icnl  Joni-n. 
Diplitheria  havinp;  Ixicoine  such  a  prevalent, 
wide-spread,  and  fatal  disease,  no  general 
practitioner  can  afford  to  lie  without  this 
work.  It  will  aid  in  preventive  measures, 
stiirinlate  promptness  in  application  of.  and 
efficiency  in,  treatment.— A'oui/iern  Practi- 
tioner, 


(19) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


s:eww 

Principles  of  Surgery. 

By  N.  Senn,  M.D.,  Ph.D.,  Professor  of  Practice  of  Surgery  and  Clinical 
Surgery  in  Rush  Medical  College,  Chicago,  111.;  Professor  of  Surgery  in  the 
Chicago  Polyclinic;  Attending  Surgeon  to  the  Milwaukee  Hospital ;"Consulting 
Surgeon  to  the  Milwaukee  County  Hospital  and  to  the  Milwaukee  County 
Insane  Asylum. 

This  work,  by  one  of  America's  greatest  surgeons,  is  thoroughly  complete; 
its  clearness  and  brevity  of  statement  are  among  its  conspicuous  merits.  The 
author's  long,  able,  and  conscientious  researches  in  every  direction  in  this 
important  field  are  a  guarantee,  of  unusual  trustworthiness,  that  every  branch  of 
the  subject  is  treated  autlioritatively  and  in  such  a  manner  as  to  bring  the 
greatest  gain  in  knowledge  to  the  Practitioner  and  Student. 

In  one  handsome  Royal  Octavo  volume,  with  109  fine  Wood-Engravings 
and  624  pages. 

United  States.  Canada  (duty  paid)    Great  Britain.  France. 

Price  in  Cloth,  $4.50,  Net        $5.00,  Net        24s.  5d.         27  fr.  20 

Sheep  or  i-Eussia,    5.50    "  6.10    "         30s.  33  fr.  10 


OMNIONS    AN»    CRITICISMS. 


Stephen  Smith,  M.D.,  Professor  of  Clini- 
cal yura;eiy  Medical  Department  University 
oi'  the  City  of  New  York,  write«  : — "  I  have 
examined  the  work  with  great  satisfaction, 
and  regard  it  as  a  most  valuable  addition  to 
American  Surgical  literature.  There  has  long 
lieen  great  need  of  a  work  on  the  principles  of 
surgery  which  would  fully  illu.-itrate  the  pres- 
ent advanced  state  of  knowledge  of  the  various 
subjects  embraced  in  this  volume.  The  work 
seems  to  me  to  meet  this  want  admirably." 

Lewis  A.  Sayre,  M.U.,  Professor  Ortho- 
paedic Surgery  Bellevue  Hospital  Medical 
College,  NeV  York,  writes : — "My  Dear  Doctor 
Senn  ;  i'our  very  valuable  work  on  surgery, 
sent  to  nie  some  time  since,  I  have  studied 
with  great  satisfaction  and  improvement.-  I 
congratulate  you  most  heartily  on  having 
produced  the  most  classical  and  practical 
work  on  surgery  yet  published." 

Fkank  J.  Lutz,  M.D,,  St.  Louis,  Mo.,  says : 
— "It  seems  hicredible  that  those  who  pretend 
to  teach  have  done  without  such  a  guide 
before,  and  I  do  not  understand  how  our  stu- 
dents succeeded  in  mastering  the  principles 
of  modern  surgery  by  attempting  to  read  our 
obsolete  text-bookfs.  American  surgery  should 
feel  proud  of  the  production,  and  the  present 
generation  of  surgeons  owe  you  a  debt  of 
gratitude." 

W.  W.  Dawson,  M.D.,  Cincinnati,  Ohio, 
writes  : — "It  is  a  work  of  great  merit,  and  one 
greatly  needed.  Reliable  Surgery  must  be 
founded  upon  correct  principles." 

Wm.  Osler,  M.D.,  The  Johns  Hopkins 
Hospital,  Baltimore,  saj's: — "You  certainly 
have  covered  the  ground'thorouglily  and  well, 
and  with  a  thoroughness  I  do  not  know  of  in 
any  similar  work.  I  should  think  it  would 
prove  a  great  boon  to  the  students  and  also  to 
very  many  teachers." 

J.  C.  Warren,  M.D.,  Boston,  Mass.,  writes  : 
— "The  book  comes  at  an  opportune  moment ; 
the  old  text-books  on  Surgical  Pathology  are 
out  of  date,  and  you  are  tilling  practically  a 
new  field." 

The  work  is  systematic  and  compact,  with- 
out a  fact  omitted  or  a  sentence  too  much, 
and  it  not  only  makes  instructive  but  fasci- 
nating reading.  A  conspicuous  merit  of  Senn's 
work  is  his  method,  his  persistent  and  tireless 
search  through  original  investigations  for 
additions  to  knowledge,  and  the  practical 
Character  of  his  discoveries.  This  combina- 
tion of  the  discoverer  and  the  practical  man 
gives  a  special  value  to  all  his  work,  and  is 


one  of  the  secrets  of  his  fame.  No  physician 
in  any  line  of  practice  can  alford  to  be  without 
Senn's  "  Principles  of  Surgery." — STie  Meview 
of  Insanity  and  Nervous  Diseases. 

Every  chapter  is  a  mine  of  information 
containing  all  the  recent  advances  on  the  sub- 
jects presented  in  such  a  systematic,  instruc- 
tive and  entertaining  style  that  the  reader 
will  not  willingly  lay  it  aside,  but  will  read 
and  re-read  with  pleasure  and  profit. — Kansas 
Medical  Journal. 

It  is  a  most  admirable  work  in  all  respects, 
and  should  be  in  the  hands  of  every  senior 
student,  general  practitioner,  and  special 
surgeon. — Canadian  Practitioner. 

After  perusing  this  work  on  several  differ- 
ent occasions  we  have  come  to  the  conclusion 
that  it  is  a  remarkable  work  by  a  man  of  vm- 
usual  ability.  We  have  never  "seen  anything 
like  it  before.  The  author  seems  to  have  had 
a  very  large  personal  experience,  which  is 
freely  made  use  of  in  the  text,  besides  which 
he  is  familiar  with  almost  all  that  has  been 
written  in  English  and  GJerraan  on  the  above 
topics.  We  congratulate  Dr.  Senn  upon  the 
manner  in  which  he  has  accomplished  his 
task.— jfVie  Canada  Medical  Record. 

The  work  is  exceedingly  practical,  as  the 
chapters  on  the  treatment  of  the  various  con- 
ditions considered  are  based  on  sovxnd  deduc- 
tions, are  complete,  and  easily  carried  out  y)y 
any  painstaking  surgeon.  Asepsis  and  anti- 
sepsis are  exhaustively  treated.  All  in  all,  the 
book  is  a  most  excellent  one.  and  deserves  a 
place  in  every  well-selecte<l  library. — Medical 
Record. 

It  will  prove  exceedingly  valuable  in  the 
diffusion  of  more  thorough  knowledge  of  the 
subject-matter  among  English-speaking  sur- 
geons. As  in  the  case  of  all  his  work,  he  has 
done  this  in  a  truly  admirable  manner.  No- 
where is  there  room  to  criticise  the  accuracy 
of  Senn's  statements,  and  everywhere  is  there 
evidence  of  a  thorough  study  of  the  best 
work  of  the  most  eminent  men.  The  book 
throughout  is  worthy  of  the  highest  praise. 
It  should  be  adopted  as  a  text-book  in  all  of 
our  schools. — University  Medical  Magazine. 

The  principles  of  surgery,  as  expounded  by 
Dr.  Senn,  are  such  as  to  place  the  student  in 
the  independent  position  of  evolving  from 
them  methods  of  treatment ;  the  master  of 
the  principles  readily  becomes  equally  a 
master  of  practice.  And  this,  of  course,  is 
really  the  whole  purpose  of  the  volume.^ 
Weekly  Medical  Review. 


(20) 


Medical  Pahlications  of  F.  A.  Davis,  Philadelphia. 


SaOEMAKEB 

Heredity,  Health,  and  Personal  Beauty. 

Including  the  Selection  of  the  Best  Cosmetics  for  the  Skin,  Hair, 
Nails,  and  all  Parts  Relating  to  the  Body. 

By  John  V.  Shoemaker,  A  M.,  M.D.,  Professor  of  Materia  ]\Ie(lica,  Phar- 
macology, Therapeutics,  and  Clinical  Medicine,  and  C'linical  Professor  of  Diseases 
of  the  Skin  in  the  Medico-Cliirurgical  College  of  Philadelphia;  Physician  to  the 
Medico-Chirnrgical  Hospital,  etc.,  etc. 

The  health  of  the  skin  and  hair,  and  how  to  promote  them,  are  discussed; 
the  treatment  of  the  nails;  the  subjects  of  ventilation,  food,  clothing,  warmth, 
bathing;  the  circulation  of  the  blood,  digestion,  ventilation;  in  fact,  all  that  in 
daily  life  conduces  to  the  well-being  of  the  body  and  refinement  is  duly  enlarged 
upon.  To  these  stores  of  popular  information  is  added  a  list  of  the  best  medicated 
soaps  and  toilet  soaps,  and  a  whole  chapter  of  the  work  is  devoted  to  household 
remedies.  The  work  is  largely  suggestive,  and  gives  wise  and  timely  advice  as 
to  when  a  physician  should  be  consulted,  lliis  is  just  the  book  to  place  on  the 
waiting-room  table  of  every  physician,  and  a  work  that  icill  jnove  useful  in  the  hands 
of  your  patients. 

Complete  in  one  handsome  Royal  Octavo  volume  of  42")  pages,  beautifully 
and  clearly  printed,  and  bound  in  Extra  Cloth,  Beveled  Edges,  with  side  and 
back  gilt  stamps  and  in  Half-Morocco  Gilt  Top. 

Price,  in  United  States,  post-paid,  Clotli,  ?.2.50;  Half- Morocco,  $3.50, 
net.  Canada  (duty  paid),  Cloth,  $2.75;  Half-Morocco,  $3.90,  net. 
Great  Britain,  Cloth,  Hs. ;  Half-Morocco,  19s.  6d.  France,  Cloth, 
15  fr.;  Half-Morocco,  22  fr. 

pleased,  and  improved. — TJie  Southern  Clinic. 

This  book  is  written  primarily  for  the  laity, 
but  will  prove  of  interest  to  the  physician  as 
well.  Though  the  author  goes  to  some  extent 
into  technicalities,  he  confines  himself  to  the 
use  of  good,  plain  Engli.'<h.  and  in  tliat  respect 
sets  a  notable  example  to  many  other  writers 
on  similar  subjects.  Furthermore,  the  book 
is  written  from  a  thoroughly  American  stand- 
pf)int. — Medical  Record. 

This  is  an  exceedingly  interesting  book, 
both  scientific  and  prac-tical  in  character,  in- 
tended for  both  professional  and  lay  readers. 
The  book  is  well  written  and  piesentcd  in  ad- 
mirable form  by  the  publisher. — Canadian 
Praclitioner. 


The  book  reads  not  like  the  fulfillment  of  a 
task,  but  like  the  researches  and  observations 
of  one  thoroughly  in  love  with  his  subject, 
fully  appreciating  its  importance,  and  writing 
for  "the  pleasure  he  experiences  in  it.  The 
work  is  very  comprehensive  and  complete  in- 
its  scope.— 3/«£/cai  World. 

The  bonk  before-  us  is  a  most  remarkable 
producti<m  and  a  most  cr.tertaining  one.  The 
hook  is  equally  well  adapted  for  the  laity  or 
the  i)rofession.  It  tells  us  how  to  be  healthy, 
happy,  and  as  beautiful  as  possible.  We  can't 
review  this  book  ;  it  is  uitTerent  from  anything 
we  liave  ever  read.  It  runs  like  a  novel,  and 
Will  be  perused  until  finished  with  pleasure 
and  profit.    Buy  it,  read  it,  and  be  surprised, 


SHOE3IAKER 


in    Diseases 
of  tlie  Skin. 


Ointments  and  Oleates  :  ^"""if.^ 

By  .John  V.  Shoemaker,  A.M.,  M.I>.,  Professor  of  Materia  Medica,  Phar- 
macology, Therapeutics,  and  C'linical  Medicine,  and  Clinical  Professor  of  Diseases 
of  the  Skin  in  the  Medico-Chirurgical  College  of  Philadelphia,  etc.,  etc. 

Tlie  author  concisely  concludes  his  preface  as  follows  :  "The  reader  may 
tliu.^  obtain  a  conspectus  of  the  whole  subject  of  inunction  as  it  exists  to-day  in 
the  civilized  world.  In  all  cases  the  mode  of  preparation  is  given,  and  the  tlicra- 
poiitical  application  described  seriatim,  hi  so  far  as  may  be  done  without  needless 
repetition  " 

•      Skcond  EniTiON,  revised  and  enlarged.     298  pages.     12mo.     Neatly  bound 
in  Dark-Blue  Cloth.    No.  0  in  the  Physician»'  and  Students'  Ready -Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  f^.  35. 

the  best  form  in  which  to  prescribe  medicines 
by  wav  of  the  skin  the  book  will  prove  valu- 
able, owing  to  the  many  prescriptions  and 
fnrniul!«  which  dot  its  pages,  while  the  copious 
index  at  the  back  mateiially  aids  in  making 
«lie  book  a  useful  one— Medical  News. 


Tt  !«  invahiable  as  a  ready  rr^frrence  wlu'ii 
ointments  or  oleates  are  to  be  used,  and  is 
Kerviceable  to  both  druggist  and  ))bysiciun. — 
Cetmida  2Icdical  Jiecord. 

To  the  physician  who  fccLs  uncertain  a."*  to 


(21) 


Medical  PuhUcations  of  F.  Ä.  Davis,  Philadelphia. 
SSOBMAKER 

Materia  IVledIca  and  Therapeutics. 

With  Especial  Reference  to  the  Clinical  Application  of  Drugs. 
J3eing  the  Second  and  Last  Volume  of  a  Treatise  on  Materia 
Medica,  Pharmacology,  and  Therapeutics,  and  an  Independent 
YoLUME  upon  Drugs. 

By  John  V.  Shoemaker,  A.M.,  M.D.,  Professor  of  Materia  Medica, 
Pharmacology,  Therapeutics,  and  Clinical  Medicine,  and  Clinical  Professor  of 
Diseases  of  the  Skin  in  the  Medico-Chirurgical  College  of  Philadelpliia;  Physician 
to  the  Medico-Chirurgical  Hospital,  etc.,  etc. 

This,  the  second  volume  of  Shoemaker's  "Materia  Medica,  Pharmacology, 
and  Therapeutics,"  is  wholly  taken  up  with  the  consideration  of  drugs,  each 
remedy  being  studied  from  three  points  of  view,  viz. :  the  Preparations,  or  Mateiia 
Medica;  the  Physiology  and  Toxicology,  or  Pharmacology;  and,  lastly,  its 
Therapy.  It  is  thoroughly  abreast  of  the  progress  of  Therapeutic  Science,  and 
is  really  an  indispensable  book  to  every  student  and  practitioner  of  medicine. 

Royal  Octavo,  about  675  pages.     Thoroughly  and  carefully  indexed. 

Price,  in  United  States,  post-paid,  Cloth,  $3.50;  Sheep,  $1.50,  net. 
Canada  (duty  paid),  Cloth,  $4.00;  Sheep,  $5.00,  net.  Great  Brit- 
ain, Cloth,  20s. ;  Sheep,  2Ss.  France,  Cloth,  22  fr.  40;  Sheep, 
28  fr.  60. 

The  first  volume  of  this  work  is  devoted  to  Pharmacy,  General  Pharma- 
cology, and  Therapeutics,  and  remedial  agents  not  properly  classed  with  drugs. 
Royal  Octavo,  353  pages. 

Price  of  Volume  I,  post-paid,  in  United  States,  Cloth,  $2.50,  net;  Sheep, 
$3.25,  net.  Canada,  duty  paid,  Cloth,  $2.75,  net;  Sheep,  $3.60,  net. 
Great  Britain,  Cloth,  Hs. ;  Sheep,  18s.  Prance,  Cloth,  16  fr.  20 ; 
Sheep,  20  fr.  20.    The  volumes  are  sold  separately. 

SHOEMAKER'S  TREATISE  ON  MATERIA  MEDICA,  PHARMACOLOGY,  AND  THERA- 
PEUTICS STANDS  ALONE. 

(1)     Amonp;  Materia  Medica  text-books,  in  that  it  includes  every  officinal  drug  and  every 

preparation  contained  in  the  United  States  Pharmacopoeia. 
(3)  ''In  that  it  is  the  only  work  on  therapeutics  giving  the  strength,  composition,  and  dosage 

of  every  officiiTal  preparation. 

(3)  In  giving  the  latest  investigations  vt^ith  regard  to  the  physiological  action  of  drugs  and 

the  most  recent  applications  in  therapeutics. 

(4)  In  combining  with  officinal  drugs  the  most  reliable  reports  of  the  actions  and  uses  of  all 

the  noteworthy  new  remedies,  such  as  acetanilid,  antipyi'in,  bromoform,  exalgin,  pyok- 
tanin,  pyridin,  soranal,  spermine  (Brown-Sequard),  tuberculin  (Koch's lymph),  sulphonal, 
thiol,  urethan,  etc.,  etc. 

(5)  As  a  complete  encyclopaedia  of  modern  therapeutics  in  condensed  form,  arranged  alpha- 

betically for  convenience  of  reference  for  either  physician,  dentist,  or  pharmacist,  when 
immediate  information  is  wanted  concerning  the  action,  composition,  dose,  or  antidotes 
for  any  officinal  preparation  or  new  remedy. 

(6)  In  giving  the  physical  characters  and  chemical  formulae  of  the  new  remedies,  especially 

the  recently-introduced  antipyretics  and  analgesics. 

(7)  In  the  fact  that  it  gives  special  attention  to  the  consideration  of  the  diagnosis  and  treat- 

ment of  poisoning  by  the  moi'e  active  drugs,  both  officinal  and  non-officinal. 

(8)  And  unrivaled  in  the  number  and  variety  of  the  prescriptions  and  practical  formulae, 

representing  the  latest  achievements  of  clinical  medicine. 

(9)  In  that,  while  summarizing  foreign  therapeutical  literature,  it  fully  recognizes  the  work 

done  in  this  department  by  American  physicians.  It  is  an  epitome  of  the  present  state 
of  American  medical  practice,  which  is  universally  acknowledged  to  be  the  best  practice. 

(10)  Because  it  is  the  most  comjilete,  convenient,  and  compendious  work  of  reference,  being, 

in  fact,  a  companion  to  the  United  States  Pharmacopoeia,  a  drug-encyclop»dia,  and  a 
therapeutic  hand-book  all  in  one  voJume. 


The  value  of  the  book  lies  in  the  fact  that 
it  contains  all  that  is  authentic  and  trust- 
worthy about  the  host  of  new  remedies  which 
have  deluged  us  in  the  last  five  years.  The 
pages  are  remarkably  free  from  useless  infor- 
mation. The  author  has  done  well  in  following 
the  alphabetical  order.— i\r.  Y.  Med.  Record. 

In  perusing  the  pages  devoted  to  the  special 
consideration  of  drugs,  their  pharmacology, 


physiological  action,  toxic  action,  and  therapy, 
one  is  constantly  surprised  at  the  amount  of 


material  compressed  in  so  limited  a  space. 
The  book  will  prove  a  valuable  addition  to  the 
physician  "s  library. — Occiuental  Med.  Times. 
It  is  a  meritorious  work,  with  many  unique 
features.  It  is  richly  illustrated  by  well-tried 
prescriptions  showing  the  practical  applica- 
tion of  the  various  drugs  discussed.  In  short, 
this  work  makes  a  pretty  complete  encyclo- 
paedia of  the  science  of  therapeutics,  conve- 
niently arranged  for  handy  reference.— ikfed. 
World. 


(22) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
S3IITH 

Physiology  of  the  Domestic  Animals. 

A  Text-Book  for  Veterinary  and  Medical  Students  and  Practitioners. 

By  Robert  Meade  Smith,  A.M.,  M.D  ,  Professor  of  Comparative  Pliysi- 
ology  in  University  of  Pennsylvania;  Fellow  of  the  College  of  Ph5\sicians  and 
Academy  of  the  Natural  Sciences,  Philadelphia;  of  American  Physiological 
Society;  of  the  American  Society  of  Naturalists,  etc. 

This  new  and  important  work,  the  most  thoroughlj'-  complete  in  the 
English  language  on  this  subject,  treats  of  the  physiology  of  the  domestic  animals 
iu  a  most  comprehensive  manner,  especial  prominence  being  given  to  the  subject 
of  toods  and  fodders,  and  the  character  of  the  diet  for  the  herbivora  under 
difTerent  conditions,  with  a  full  consideration  of  their  digestive  peculiarities. 
Without  being  overburdened  with  details,  it  forms  a  complete  text-book  of 
phj^siology  adapted  to  the  use  of  students  and  practitioners  of  both  veterinary 
and  human  medicine.  This  work  has  already  been  adopted  as  the  Text-Book  on 
Physioloüy  in  the  Veterinary  Colleges  of  the  United  States,  C4reat  Britain,  and 
Canada,  "in  one  Handsome  Royal  Octavo  Volume  of  over  950  pages,  profusely 
illustrated  with  more  than  4J0  Fine  Wood-Engravings  and  many  Colored  Plates. 


Price,  Cloth, 
"     Sheep, 


United  States. 

$5.00,  Net 
6.00    " 


Canada  (duty  paid) 

$5.50,  Net 
6.60    " 


Great  Britain. 

283. 
32s. 


France. 

30  fr.  30 
36  fr.  20 


A.  Li.^UTARD,  M.D.,  H.F.R.C.  V.S.,  Pro- 
fes-sor  of  Anatomy,  Operative  Surgery,  and 
Sanitary  Medicine  in  the  American  veterinary 
College",  New  York,  writes:— "I  have  exam- 
ined the  work  of  Dr.  R.  M.  Smith  on  the 
'Physiology  of  the  Domestic  Animals,'  and  (hiii- 
sideV  it  one  of  the  best  additions  to  veterinary 
literature  that  we  have  ha,d  for  some  time." 

E.  M.  Reading,  A.M.,  M.D.,  Professor  of 
Physiology  in  the  Chicago  Veterinary  College, 
writes: — "I  have  carefully  examined  the 
'Sndth's  Physiology,'  pul)lishcd  liy  you,  and 
like  it.  It  is  comj  rehensive,  exhaustive,  and 
comi)lete,  and  is  especially  adapted  to  those 
who  de.sire  to  obtain  a  full  knowledge  of  the 
principles  of  physiology,  and  are  not  s;itislicd 
with  a  mere  smattering  of  the  cardinal  points." 

Dr.  Smith's  presentment  of  h's  subject  is  as 
brief  as  the  status  of  the  science  iiei  inits,  and 
to  this  much-desired  conciseness  he  has  added 
an  etjually  welcome  clearness  of  statement. 
The  illustrations  in  the  work  arc  exceedingly 
good,  and  must  i)rove  a  valuable  aid  to  the 


full  understanding  of  the  \e.j.t.— Journal  of 
Comparative  Medicine  and  Surgery. 

Veterinary  practitioners  and  graduates  will 
read  it  with  pleasure.  Veterinary  students 
will  readily  acquire  needed  knowledge  from 
its  pages,  and  veterinary  schools,  which  would 
be  well  equipped  for  the  work  they  aim  t© 
perform,  cannot  ignore  it  as  their  text-book 
in  physiokigy. — Aviericaii  Veterinary  Review. 

Altogether,  Professor  Smith's  "  Physiology 
of  the  Domestic  Animals"  is  a  happy  produc- 
tion, and  will  be  hailed  with  delight  in  both 
the  human  medical  and  veterinary  medical 
worlds.  It  should  find  its  place,  besides,  in  all 
agricultural  libraries.— Paxil,  Paqiiin,  M.D., 
\  .S.,  in  the  Weekly  Medical  Jievirw. 

The  author  has  judiciously  made  the  nutri- 
tive funclifnis  the  strong  point  of  the  work, 
and  has  devoted  special  attention  to  the  sub- 
ject ol:'  foods  and  digestion.  In  looking 
through  other  sections  of  the  work,  it  appears 
to  us  that  a  just  projiortionof  s|)aceis  assigned 
to  each,  in  view  of  their  relative  importance 
to  the  practitioner. — London  Lancet. 


SOZINSKEY 


Medical  Symbolism. 


Historical  Studies  in  tlie  Arts 
of  Healing:  and  Hygiene. 

By  TiiOMAB  S.  SoziN.sKKY,  M.D.,  Ph. I),,  Author  of  "The  Culture  of 
Beauty."  "Tlie  Care  and  Culture  of  Children,"  etc. 

12ino.  Nearly  200  pages.  Neatly  bound  lit  Dark-Blue  Cloth.  Appropri- 
ately illustrated  with  upward  of  thirly  (:50)  new  Wood-Engravings.  No.  'J  in  the 
Physicians'  and  Students'  Ready- Reference  Series. 

Price,  post-paid,  in  United  States  and  Canada,  $1.00,  net ;  Great 
Britain,  6s. ;  France,  6  fr.  20. 

He  who  has  not  time  to  more  fully  study  the 
more  extended  records  of  the  past,  will  highly 
prize  this  little  hook.  It»  interesting  discourse 
up'T  the  past  is  full  of  suggestive  thought. — 
Americun  Lancet. 

IJko  an  oasis  in  a  dry  and  dusty  desert  of 
medical  literature,  through  which  we  wearily 
stngu'er.  is  this  work  devoted  to  medical  sym- 
holifiin  anrl  mythology.  .\h  the  author  aptly 
quotec:  "  Whatsonie  light  l)rairics  m.iy  esteem 
as  iooWhh  toyes,  deeper  judgments  can  and 


will  value  as  sound  and  serious  matter."— Can- 
adiun  Practitioner. 

In  the  volume  before  us  wo  have  an  admira- 
ble and  successful  attempt  to  set  forth  in 
order  those  medical  symbols  which  have  como 
down  tons,  and  toexnlain  onhistoricalgrouiids 
their  significance.  An  astonishing  amount  of 
information  »contained  within  tlio  covers  of 
the  book,  and  every  page  of  the  work  bears 
token  of  the  jiainstaking  genius  and  erudite 
mind  of  the  now  unhappily  deceased  author. 
— London  Lancet, 


(28) 


iledical  Publications  of  F.  A.  Davis,  Philadelphia. 


STEW  AMT 


lynopsis. 


By  John  S.  Stewart,  M.D.,  formerly  Demonstrator  of  Obstetrics  and 
Chief  Assistant  in  tlie  Gynaecological  Clinic  of  the  Medico-Chirurgical  College 
of  Philadelphia:  with  an  introductory  note  by  William  S.  Stewart,  A.M., 
]M.D.,  Piofessor  of  Obstetrics  and  Gynaecology  iu  the  Medico-Chirurgical  College 
of  Philadelphia. 

By  students  this  work  will  be  found  particularly  useful.  It  is  based  upon 
the  teachings  of  such  well-known  authors  as  Playfair,  Parvin,  Lusk,  Galabin, 
and  Cazeaux  and  Tarnier,  and  contains  mucli  new  and  important  matter  of  great 
value  to  both  student  and  practitioner. 

With  42  Illustrations.  202  pages.  12mo.  Handsomely  bound  in  Dark- 
Blue  Cloth.     No.  1  in  the  Phyücians'  and  Students'  Beady -Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net ;  in  Great 
Britain,  6s.;  Prance,  6  fr.  20. 


DeLaskie  MiLiiER,  M.D.,  Professor  of 
Obstetrics,  Rush  Medical  College,  Chicago, 
111.,  says : — "I  have  examined  the  'Obstetric 
Synopsis,'  by  John  S.  Stewart,  M.D.,  and  it 
Rives  me  pleasure  to  characterize  the  work  as 
systematic,  concise,  perspicuous,  and  authen- 
tic.   Among  manuals  it  is  one  of  the  best." 

It  is  well  written,  excellently  illustrated, 
and  fully  up  to  date  in  every  respect.  Here 
we  find  all  the  essentials  of  Obstetrics  in  a 
nutshell,  Anatomy,  Embryology,  Fhy.siology, 
Pregnancy,  Labor,  Puerperal  State,  and  Ob- 
stetric Operations  all  being  carefully  and  ac- 


curately described. — Buffalo  Medical  and 
Surgical  Journal. 

It  is  clear  and  concise.  The  chapter  on  the 
development  of  the  ovum  is  especially  satis- 
factory. The  judicious  use  of  bold-faced 
type  for  headings  and  italics  for  important 
statements  gives  the  book  a  plea.sing  typo- 
graphical appearance. — Medical  Record. 

This  volume  is  done  with  a  masterly  hand. 
The  scheme  is  an  excellent  one.  The  whole 
is  freely  and  most  admirably  illustrated  with 
well-drawn,  new  engiaviugs,  and  the  book  is 
of  a  very  convenient  size. — 8t.  Louis  Medical 
and  Surgical  Journal. 


ULTZMAJSrW 

The  Neuroses  of  the  Genito-Urinary  System 

in  the  Male. 

With  Sterility  and  Impotence, 

By  Dr.  R.  Ultzmann,  Professor  of  Genito-Urinary  Diseases  in  the  Uni- 
versity of  Vienna.  Translated,  with  the  author's  permission,  by  Gardner  W. 
Allkn,  M.D.,  Surgeon  in  the  Genito-Urinary  Department,  Boston  Dispensary. 

Full  and  complete,  yet  terse  and  concise,  it  handles  the  subject  with  such 
a  vigor  of  toueh,  sucli  a  clearness  of  detail  and  description,  and  such  a  directness 
to  the  result,  that  no  medical  man  who  once  takes  it  up  will  be  content  to  lay  it 
down  until  its  perusal  is  complete, — nor  will  one  reading  be  enough. 

Professor  Ultzmann  has  approached  the  subject  from  a  somewhat  different 
point  of  view  from  most  surgeons,  and  this  gives  a  peculiar  value  to  the  work. 
It  is  believed,  moreover,  that  there  is  no  convenient  hand-book  in  English  treat- 
ing in  a  broad  manner  the  Genito-Urinary  Neuroses. 

Synopsis  op  Contknts. — First  Part — I.  Chemical  Changes  in  the  Urine  in 
Cases  of  Neuroses.  II.  Neuroses  of  the  Urinary  and  of  tlie  Sexual  Organs, 
classified  as  :  (1)  Sensory  Neuroses;  (2)  Motor  Neuroses  ;  (3)  Secretory  Neuroses. 
Second  Part — Sterility  and  Impotence.  The  treatment  in  all  cases  is  described 
clearly  and  minutelJ^ 

"^Illustrated.  i2mo.  Handsomely  bound  in  Dark-Blue  Cloth.  No.  4.  in  the 
Physicians'  and  Students'  Ready-Reference  Series. 

Price,  post-paid,  in  the  United  States  and  Canada,  $1.00,  net ;  in  Great 
Britain,  6s. ;  in  France,  6  fr.  20. 

minted  of  his  delightful  manner  of  iiresenting 
his  thoughts,  which  ever  sparkle  with  orijfinal- 
ity  and  appositeness.— TTeefc^j/  Med.  Revieiv. 

It  engenders  sound  pathological  teaching, 
and  will  aid  in  no  small  degree  in  liirowing 
light  on  the  management  of  many  of  the  dif- 
ficult and  more  refractory  cases  of  the  classes 
to  which  these  essays  especially  refer.— rAe 
Medical  Age. 


This  book  is  to  be  highly  recommended, 
owing  to  its  clearness  and  brevity.  Altogether, 
we  di)  not  know  of  any  book  of  the  same  size 
which  contains  so  much  useful  information  in 
such  a  short  sp2t,c&.— Medical  News. 

Its  scope  is  large,  not  being  confined  to  the 
eoie  condition, — neurasthenia, — but  embracing 
all  of  the  neuroses,  motor  and  sensory,  of  the 
genito-urinary  organs  in  the  male.  No  one 
wbr.  has  read  after  Dr.  Ultzmann  need  be  re- 


(24) 


Medical  Publications  of  F.  A.  Davis,  Plnladelpliia. 
WHEBLJEJR 

Abstracts  of  Pharmacology. 

By  H.  A.  Wheeler,  M.D.  (Registered  Pharmacist,  No.  3468,  Iowa).  Pre- 
pared for  the  use  of  Physicians  and  Pharmacists,  and  especially  for  the  use  of 
Students  of  Medicine  and  Pharmac3^  who  are  preparing  for  Examination  in 
Colleges  and  before  State  Boards  of  Examiners. 

This  book  does  not  contain  questions  and  answers,  but  solid  pages  of 
abstract  information.  It  will  be  an  almost  indispensable  companion  to  the  prac- 
ticing Pharmacist,  and  a  very  useful  reference-book  to  the  Physician.  It  contains 
a  brief  but  thorough  explanation  of  all  terms  and  processes  used  in  practical 
pharmacy,  an  abstract  of  all  tliat  is  essential  to  be  known  of  each  officinal  drug,, 
its  preparations  and  therapetic  action,  with  doses;  in  Chemistry  and  Botany, 
much  that  is  useful  to  the  Physician  and  Pharmacist;  a  general  working  formula 
for  each  class  and  an  abstract  fonnula  for  each  ofläcinal  preparation,  and  many  of 
the  more  popular  unofficinal  ones,  together  with  their  doses;  also  many  symbolic 
formulas;  a  list  of  abbreviations  used  in  prescription  writing;  rules  governing 
incompatibilities;  a  list  of  Solvents;  tests  for  tlie  more  common  drugs;  the  habitat 
and  best  time  for  gathering  plants  to  secure  their  medical  properties. 

The  book  contains  180  pages,  5^  x  8  inches,  closely  printed  and  on  the  best 
paper,  nicely  and  durably  bound,  containing  a  greater  amount  of  information  on 
Xlie  above  topics  than  any  other  work  for  the  money. 

Price,  post-paid,  in  United  States  and  Canada,  $1.50,  net;  in  Great 
Britain,  8s.  6d. ;  in  France,  9  fr.  35. 


YOUNG 

Synopsis  of  Human  Anatomy. 

Being  a  Complete  Compend  of  Anatomy,  Including  the  Anatomy  op 
THE  Viscera,  and  Numerous  Tables. 

Bj'  J.AMES  K.  Young,  M.D.,  Instructor  in  Orthopaedic  Surgery  and  Assistant 
Demonstrator  of  Surgery,  University  of  Pennsylvania;  Attending  Orthopaedic 
Surgeon,  Out-Patient  Department,  University  Hospita],  etc. 

While  the  author  has  prepared  this  work  especially  for  students,  sufficient 
descriptive  matter  has  been  added  to  render  it  extremely  valuable  to  the  busy 
practitioner,  particularly  the  sections  on  the  Viscera,  Special  Senses,  and  Sur- 
gical Anatomy. 

The  work  includes  a  complete  account  of  Osteology,  Articulations  and 
Ligaments,  Muscles,  Fascias,  Vascular  and  Nervous  Systems,  Alimentary,  Vocal, 
and  Respiratory  and  Genito-Urinary  Apparatus,  the  Organs  of  Special  Sense, 
and  Surgical  Anatomy. 

In  addition  to  a  most  carefully  and  accurately  prepared  text,  wherever 
possible,  the  value  of  the  work  has  been  enhanced  by  tables  to  facilitate  and 
minimize  the  labor  of  students  in  acquiring  a  thorough  knowledge  of  tiiis 
important  subject.  The  section  on  llie  teetli  has  also  been  especially  prepared 
to  meet  the  requirements  of  students  of  dentistry. 

Illustrated  with  70  Wood-Engravings.  äOO  pages.  12mo.  No.  3  in  the 
Physicians'  and  Students'  Ready -Reference  Series. 

Frice,  post-Tiaid,  in  united  States  and  Canada  $1.40,  net ; 
Great  Britain,  8s.  6d. ;  France,  9  fr.  25. 


Every  nniifcfrsHary  word  tia«  lip.en  cxchiiled, 
out  «f  VfRard  to  the  vr-ry  limited  time  :it  tlie 
medical  KtiirlenfH  «IJKposal.  It  i.s  alHO  (^ood  a.s 
a  referenee-l»ook.  a«  it  jireHent»  tlic  facts  ;il)Ont 
whieli  lie  wiftlwH  to  refresh  liin  memory  in  tlie 
trriefeKt  manner  eoiiHiHteiit  with  cUianieM». — 
New  York  Mrdical  Journal. 

Ah  a  eomiianioii  to  the  dinsectinp-table,  anil 
a  convenient  reference  for  the  iiractitioner,  it 

(2.5) 


lian  a  definite  field  of  usefulness.— jPtifafeMj'f/ft 
Medical  Review. 

The  book  is  much  more  satisfactory  than  the 
"reinendiraiiecH  "  in  voRiie,  and  yet  is  not  too 
emiiliersome  to  be  carried  around  iind  road  at 
od(l  nioments^a  jirojierty  which  the  student 
will  readily  appreciate.  —  Weekly  Medical 
Review. 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
WITHEMSTINE 

The  International  Pocket  Medical  Fornnulary 

Arranged  Therapeutically. 

By  C.  Sumner  Witherstine,  M.S.,  M.D.,  Associate  Editor  of  the 
'Annual  of  the  Universal  Medical  Sciences  ;"  Visiting  Physician  of  the  Home 
for  the  Aged,  Germantown,  Philadelphia  ;  Late  House-Surgeon  Charity  Hospital, 
New  York. 

More  than  1800  formulae  from  several  hundred  well-known  authorities. 
With  an  Appendix  containing  a  Posological  Table,  the  newer  remedies  included  ; 
Important  Incompatibles  ;  Tables  on  Dentition  and  the  Pulse  ;  Table  of  Drops 
in  a  Fluidrachm  and  Doses  of  Laudanum  graduated  for  age  ;  Formulae  and  Doses 
of  Hypodermatic  Medication,  including  the  newer  remedies  ;  Uses  of  the  Hypo- 
dermatic Syringe  ;  Formulae  and  Doses  for  Inhalations,  N'asal  Douches,  Gargles, 
and  Eye-washes  ;  Formulae  for  Suppositories  ;  Use  of  the  Thermometer  in  Dis- 
ease ;  Poisons,  Antidotes,  and  Treatment ;  Directions  for  Post-Mortem  and 
Medico-Legal  Examinations  ;  Treatment  of  Asphyxia,  Sun-stroke,  etc.  ;  Anti- 
emetic Remedies  and  Disinfectants  ;  Obstetrical  Table  ;  Directions  for  Ligations 
of  Arteries  ;  Urinary  Analysis  ;  Table  of  Eruptive  Fevers  ;  Motor  Points  for 
Electrical  Treatment,  etc. 

This  work,  the  best  and  most  complete  of  its  kind,  contains  about  275 
printed  pages,  besides  extra  blank  leaves — the  book  being  interleaved  throughout 
— elegantly  printed,  with  red  lines,  edges,  and  borders;  with  illustrations.  Bound 
in  leather,  with  side  flap. 

It  is  a  handy  book  of  reference,  replete  with  the  choicest  formulse  (over 
1800  in  number)  of  more  than  six  hundred  of  the  most  prominent  classical  writers 
and  modern  practitioners.  . 

The  remedies  given  are  not  only  those  whose  eflBciency  has  stood  the  test 
of  time,  but  also  the  newest  and  latest  discoveries  in  pharmacy  and  medical 
science,  as  prescribed  and  used  by  the  best-known  American  and  foreign  modei-n 
authorities. 

It  contains  the  latest,  largest  (66  formulae),  and  most  complete  collection  of 
hypodermatic  formulae  (including  the  latest  new  remedies)  ever  published,  with 
doses  and  directions  for  their  use  in  over  fifty  different  diseases  and  diseased 
conditions. 

Its  appendix  is  brimful  of  information,  invaluable  in  office  work,  emergency 
cases,  and  the  daily  routine  of  practice. 

It  is  a  reliable  friend  to  consult  when,  in  a  perplexing  or  obstinate  case,  the 
usual  line  of  treatment  is  of  no  avail.  (A  hint  or  a  help  from  the  best  authorities, 
as  to  choice  of  remedies,  correct  dosage,  and  the  eligible,  elegant,  and  most  palat- 
able mode  of  exhibition  of  the  same.) 

It  is  compact,  elegantly  printed  and  bound,  well  illustrated,  and  of  conve- 
nient size  and  shape  for  the  pocket. 

The  alphabetical  arrangement  of  the  diseases  and  a  thumb-letter  index 
render  reference  rapid  and  easy. 

Blank  leaves,  judiciously  distributed  throughout  the  book,  afford  a  place  to 
record  and  index  favorite  formulae. 

As  a  student,  the  physician  needs  it  for  study,  collateral  reading,  and  for 
recording  the  favorite  prescriptions  of  his  professors,  in  lecture  and  clinic;  as  a 
recent  graduate,  he  needs  it  as  a  reference  hand-book  for  daily  use  in  prescribing 
(gargles,  nasal  douches,  inhalations,  eye-washes,  suppositories,  incompatibles, 
poisons,  etc.);  as  an  old  practitioner,  he  needs  it  to  refresh  his  memory  on  old 
remedies  and  combinations,  and  for  information  concerning  newer  remedies  and 
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Great  Britain,  lis.  6d. ;  France,  12  fr.  40. 

enough  of  incompatibilities  before  commenc- 
ing practice  to  avoid  writing  incompatible  and 
dangerous  prescriptions.  The  constant  use  of 
such  a  book  by  such  prescribers  would  save 
the  phavmacist  much  anxiety.— 27te  Drug- 
gists^ Circular. 

In  judicious  selection,  in  accurate  nomen- 
clature, in  arrangement,  and  in  style,  it  leaves 
nothing  to  be  desired.  The  editor  and  the 
publisher  are  to  be  congratulated  on  the  pro- 
duction of  the  very  best  book  of  its  class. — 
Pittsburgh  Medical  Review. 


It  is  sometimes  important  that  such  prescrip- 
tions as  have  been  well  established  in  their 
usefulness  be  preserved  for  reference,  and 
this  little  volume  serves  such  a  purpose  better 
than  any  other  we  have  seen. — Columbus  Med- 
ical Journal. 

To  the  young  physiciun  Just  starting  out  in 
practice  this  little  book  will  prove  an  accept- 
able companion. — Omaha  Clinip. 

As  long  as  "combinations"  are  sought,  such 
a  book  will  be  of  value,  especially  to  those 
who  cannot  spare  the  time  required  to  learn 


(26) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 

Annual  of  the  Universal  Medical  Sciences. 

A  Yearly  Report  of  the  Progress  of  the  General  Sanitary 
Sciences  Throughout  the  World. 

Edited  by  Charles  E.  Sajous,  M.D.,  formerly  Lecturer  on  Laryngology 
and  Rhiuology  iu  Jetferson  Medical  College,  Philadelphia,  etc.,  and  Seventy 
Associate  Editors,  assisted  by  over  Two  Hundred  Corresponding  Editors  and 
Collaborators.  In  Five  Royal  Octavo  Volumes  of  about  500  pages  each,  bound 
in  Cloth  and  Half-Russia,  Magnificently  Illustrated  with  Chromo-Lithographs, 
Engravings,  Maps,  Charts,  and  Diagrams.  Being  intended  to  enable  any  physi- 
cian to  possess,  at  a  moderate  cost,  a  complete  Contemporary  History  of  Universal 
Medicine,  edited  by  many  of  America's  ablest  teacliers,  and  superior  in  every 
detail  of  print,  paper,  binding,  etc.,  a  befitting  continuation  of  such  great  works 
as  "Pepper's  SA'stem  of  Medicine,"  "  Ashhurst's  International  Encyclopaedia  of 
Surgery,"  "Buck's  Reference  Hand-Book  of  the  Medical  Sciences." 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON   RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Subscription  Price  per  Year  (including  the  "  SATELLITE  "  for  one  year) : 
In  United  States,  Cloth,  5  vols.,  Royal  Octavo,  $15.00 ;  Half-Russia,  5  vols., 
Royal  Octavo,  $20.00.  Canada  (duty  paid),  Cloth,  $16  50;  Half-Russia, 
$22.00.  Great  Britain,  Cloth,  £>i  7s. ;  Half-Russia,  £5  15s.  France,  Cloth, 
93  fr.  95 ;  Half-Russia,  12i  fr.  35. 

The  Satellite  of  the  "Annual  of  the  universal  Medical  Sciences."  A 
Monthly  Review  of  the  most  important  articles  upon  the  practical  branches  of 
Medicine  appearing  in  the  medical  press  at  large,  edited  by  the  Chief  Editor  of 
the  Annual  and  an  able  staff.  Published  in  connection  with  the  Annual,  and 
for  its  Subscribers  Only. 


Editorial  Staff  of  the  Annual  of  the  Universal  Medical  Sciences. 

COXTRIBUTORS  TO  SERIES  1888,  1889,  1890,  1891. 

Editor-in-Chief,  CHARLES  E.  SAJOUS,  M.D.,  Philadelphia. 


SENIOR   ASSOCIATE    EDITORS. 

Agiiew.  1).  Havfts,  M.D.,   LL.D.,  Philadelphia, 

series  of  1KH8.  18K9. 
Baldy,  J.  M..  M.D..  Philadelphia,  1891. 
Barton,   .T.  M.,  A.M.,  M.D.,  Philadelphia.  1889, 

1S90   IJ^l 
BIrdsall,  w'.  R.,   M.D.,  New  York,  1889,  1890, 

18Ö1. 
Brown,  F.  W.,  M.D..  Detro  t,1890,  1801. 
Bruen,  PMwardT..  M.D.,  Philnd(li)liia,  1889. 
Brush,   Kdward  N.,   M.D.,  Philaclelphia,  1889, 

1890.  mn. 

Cohen.  .1.  Solis,  M.D.,  Philadelphia,  1888,  1889, 

1890,  1891. 
Conner,   P.  H..  M.D.,   LL.D.,  Cincinnati,  1888, 

IW«.  1890.  1891. 
Currier,  A,   K,  A.B.,  M.D.,  New  York,   1889, 

18JW.  1891. 
DavidMon.  C.  C.,  M  l>..  Phila/lelphia.  1888. 
Davit«.  N.  H..  A.M.,  .M.D.,  LL.D.,  Chicago.  1888, 

1K89,  18!K).  IS91. 
Delafteld,  Francis,  .M.D..  New  York.  1888. 
Delavan.   f».   I'.rvson,  M.D.,    New   York,   1888, 

18«».  IS9f).  iHffl. 
Dranr-r.  F.  Wintlirop.  A.M.,  M.D.,  New  York, 

1S88.  IKH',1.  18tW.  1891. 
Dudley.  Fdward  C,  M.D.,  <hif  aqro,  1888. 
Ernst.    Harold  C,   A.M.,  M.D.,  Boston,   1889, 

1S90,  1891. 
ForLfH,  William  H.,  M.D.,  Philadelphia,  1888, 

jmt.  iwio. 

Garret^on,    J.   E.,   M.D.,    Philadelphia,    1888, 
IS». 


Ga.«ton,  J.   McFadden,  M.D.,    Atlanta,    1890, 

1891. 
Gihoii.  Albert  L.,  A.M.,  M.D.,  Brooklyn,  1888, 

1889.  18m.  1891. 
Good'>ll.  William.   M.D..    Philadelphia,    1888, 

1889.  1890. 

Grav.  Landon  Carter,  M.D.,  NewYork,  1890, 

1891. 
Griffith.  .T.  P.  Crozer,  M.D.,  Philadelphia,  1889, 

1890.  1891. 

Guilford,  S.  H.,  D.D.S.,  Ph.D.,  Philadelphia, 

Guiteras.  .John,  M.D.,  Ph,D.,  Charleston,  1888, 

1889. 
Hamilton,  .lohn  H..  INl.D.,  LL.D.,  Washington, 

1888.  1889,  1890.  1891. 
Hare.   Hohart  Aniorv.  MD.,  B.Sc,  Philadel- 
phia. 1888,  1889.  189«,  1891. 
Henrv.  Frederick  P.,  M.D.,  Philadelphia,  1889, 

1890,  1891.  * 

Holland,  .1.  W.,  M.D..  Philadelphia,  1SS8.  1889. 
Holt.  li.  Emniett.  M.D.,  New  Yoik,  1889,  1890, 

1891. 
Howell.   W.     IT..    Ph.D.,   M.D.,   Ann    Arbor, 

188}».  1890,  1S91. 
Hun.  Henry,  M.D..  Albany,  1889.  1890. 
Hooper.  Franklin  H.,  M.D..  Boston,  1890.  1891. 
Innals.  K.  Fletcher,  A.M.,  M.D.,  Chicago,  1889, 

1890,  1S91. 
JacKard,  W,  W.,  A.M.,  M.D.,  Chicago.  1890. 
Johnston,  Christopher,  M.D.,  lialtiinorc,  1S88, 

1889. 
Johnston.  W.  W.,  M.D.,  Washington,  1888, 1889, 

1890,  1891. 


(27) 


Medical  Puhlicatiom  of  F.  A.  Davis,  Philadelphia, 


SENIOR  ASSOCIATE    EDITORS 

(continued). 

Keating,  John  M.,  M.D.,  Philadelphia,  1889. 
Kelsey,  Charles  B.,  M.D.,  New  York,  1888, 1889, 

1800,  1891. 
lieyes,   Edward  L.,  A.M.,  M.D.,  New  York, 

1888,  1889,  1890,  1891. 

Knapp,  Philip  Coombs,  JVI.D.,  Boston,  1891. 
Laplace,    Ernest,  A.M.,  M.D.,  Philadelphia, 

1890.  1891. 
Lee,  John  G.,  M.D.,  Philadelphia,  1888. 
Leidy,  Joseph,  M.D.,  LL.D.,  Philadelphia,  1888, 

1889,  1890,  1891. 

Longstreth,  Morris,  M.D.,  Philadelphia,  1888, 

1S89,  1890. 
Loomis,  Alfred  L.,  M.D.,   LL.D.,  New  York, 

1888,  1889. 
Lyman,  Henry  M.,  A.M.,  M.D.,  Chicago,  1888. 
McGuire,  Hunter,   M.D.,   LL.D.,   Richmond, 

1888. 
Manton,  Walter  P.,  M.D.,  F.R.M.S.,  Detroit, 

1888,  1889.  1890,  1891. 

Martin,  H.  Newell,  M.D.,  M.A.,  Dr.  Sc,  F.KS., 

Baltimore,  1888, 1889. 
Matas,   Rudolph,    M.D.,  New    Orleans,    1890, 

1891. 
Mears,  J.  Ewing,  M.D.,  Philadelphia,  1888, 1889, 

1890,  1891. 

Mills,  Charles  K.,  M.D.,  Philadelphia,  1888. 
Miuot,   Clias.    Sedgwick,   M.D.,  Boston,  1888, 

1889,  1890,  1891.  " 

Montgomery,  E.  E.,  M.D.,  Philadelphia,  1891. 
Morton,  Thos.  G.,   M.D.,   Philadelphia,   1888, 

1889. 
Munde',  Paul  F.,  M.D.,  New  York,  1888,  1889, 

1890,  1891. 

Oliver,  Charles  A.,  A.M.,  M.D.,  Philadelphia, 

1889,  1890,  1891. 
Packard,  John  H.,  A.M.,  M.D.,  Philadelphia, 

1888,  1889,  1890,  1891. 

Parish,  Wm.H.,  M.D.,  Philadelphia,  1888, 1889, 
1890. 

Parvin,  Theophilus,  M.D.,  LL.D.,  Philadel- 
phia, 1888,  1889. 

Pierce,  C,  N.,  D.D.B.,  Philadelphia,  1888. 

Pepper,  William,  M.D.,  LL.D.,  Philadelphia, 
18S8 

Rannev,  Ambrose  L.,  M.D.,  New  York,  1888, 

1889,  1890. 

Rich.ardson,  W.  L.,  M.D.,Boston,  1888,  1889. 
Rockwell,  A.  D.,  A.M.,  M.D.,  New  York,  1891. 
Rohe',  Geo.  H.,  M.D.,  Baltimore.  1888, 1889, 1890, 

1891. 
Sajous,  Chas.  E.,  M.D.,  Philadelphia.  1888, 1889, 

1890, 1891. 
Sayre,  Lewis  A.,M.D.,  New  York,  1890,  1891. 
Seguin,  E.  C,  M.D.,    Providence,   1888,   1889, 

1890,  1891. 

Senn,  Nicholas,  M.D.,  Ph.D.,  Milwaukee,  1888, 

1889. 
Shakspeare,  E.  O.,  M.D.,  Philadelphia,  1888. 
Sbattuck,  P.  C,  M.D.,  Boston,  1890. 
Smith,  Allen  J.,  A.M.,  M.D.,  Philadelphia,  1890, 

1891. 
Smith,  J.  Lewis,  M.D.,  New  York,  1888,  1889, 

1890,  1891. 
Spitzka,  R.  C,  M.D.,  New  York,  1888. 
Starr,   Louis,   M.Ü.,   Philadelphia,  1888,  1889, 

1890.  1891. 
Stimson.  Lewis  A.,  M.D.,  New  York,  1888, 1889, 

1890,  1891. 
Siuvgis,  F.  R.,  M  D.,  New  York,  1888. 
Suddutb,  F.  X.,  A.M..  M.D..  F.R.M.S.,  Minne- 
apolis, 1888,  1889,  1890, 1891. 
Thomson,  William,  M.D.,  Philadelphia.  1888. 
Thomson.  Wm.  H.,  M.D..  New  York,  1888. 
Tiftanv,  L.   McLane,  A.M.,  M.D.,  Baltimore, 

1890,  1891. 
Turnbull,  (;iias.  S.,  M.D.,  Ph.D.,  Philadelphia, 

1888,  1889,  1890  1891. 
Tyson.  James,  M.D.,  Philadelphia,  1888,  1889, 

1890. 
Van  Harlingen,  Arthur,  M.D.,  Philadelphia, 

1888,  1889,  1890, 1891. 
Vandev  Veer,  Albert,  M.D.,  Ph.D.,  Albany, 

1890. 
Whittaker,  .Tas.  T.,  M.D.,  Cincinnati,  1888, 1889, 

1890, 1891. 
Whittier,  E.  N.,  M.D.,  Boston,  1890,  1891. 
Wilson,  James  C,  A.M.,   M.D.,  Philadelphia, 

1888. 1889.  1890,  1891. 


Wirgman,  Chas.,  M.D.,  Philadelphia,  1888. 

Witherstine,  C.  Sumner,  M.S.,  M.D.,  Phila- 
delphia, 1888,  1889,  1890,  1891. 

White,  J.  William,  M.D.,  Philadelphia,  1889, 
1890,  1891.  , 

Young,  Jas.  K.,  M.D.,  Philadelphia,  1891. 

JUNIOR   ASSOCIATE    EDITORS. 

Baldy,  J.  M.,  M.D.,  Philadelphia,  1890. 

Bliss.  Arthur  Ames,  A.  M.,  M.D.,  Philadelpliia, 
1890,  1891. 

Cattell,  H.  W.,  M.D..  Philadelphia,  1890,  1891. 

Cerna,  David,  M.D.,  PbD.,  Philadelphia,  1891. 

Clark,  J.  Payson.  M.D.,  Boston,  1890,  1891. 

Crandall,  F.  M.,  M.D.,  New  York,  1891. 

Cohen,  Solomon  Solis,  A.M.,  M.D.,  Philadel- 
phia, 1890,  1891, 

Cryer,  H.  M.,  M.D.,  Philadelphia,  1889. 

Deale,  Henry  B.,  M.D.,  Washington,  1891. 

Dolley,  C.  S.,  M.D.,  Philadelphia,  1889,  1890, 
1891. 

Dollinger.  Julius,  M.D.,  Philadelphia,  1889. 

Dorland,  W.  A.,  M.D.,  Philadelphia,  1891. 

Freeman,  Leonard,  M.D.,  Cincinnati,  1891. 

Goodell,  W.  Constantine,  M.D.,  Philadelphia, 

1888,  1889,  1890. 

Gould,  Geo.  M.,  M  J).,  Philadelphia,  1889,  1890. 

Greene,  E.  M..  M.D.,  Bostoii,  1891. 

Griffith,  J.  P.  Crozer,  M.D.,  Philadelphia,  1883. 

Hoag,  Junius,  M.D.,  Chicago,  1888. 

Howell,  W.  H.,  PhD.,  B.A.,  Baltimore,  1888, 

1889. 
Hunt,  William,  M.D.,  Philadelphia,  1888,  1889. 
Jackson.  Henry,  M.D.,  Boston,  1891. 
Kirk,  Edward  C,  D.D.S.,  Philadelphia,  1888. 
Lloyd,  James   Hendrie,  M.D.,  Philadelphia, 

1888 
McDonald,  Willis  G.,  M.D.,  Albany,  1890. 
Penrose,  Chas.  B.,  M.D.,  Philadelphia,  1890. 
Powell,  W.  M.,  M.D.,  Philadelphia,  1889,  1890, 

1891. 
Quimby,  Chas.  E..  M.D.,  New  York,  1889. 
Sayre,  Reginald  H.,  M.D.,  New  York,  1890, 1891. 
Smith,    Allen  J.,  A.M.,   M.D.,    Philadelphia, 

1889,  1890. 

Vickery,  H.  F.,  M.D.,  Boston,  1891. 
Warfleld.  Ridgelv  B.,  M.D.,  Baltimore,  1891. 
Warner,  Frederick  M.,  M.D..  New  York,  1891. 
Weed.  Charles  L.,  A.M.,  M.D.,  Philadelphia, 

1888  1889 
Wells,  ferooiis  H.,  M.D.,  New  York,  1888,  1889, 

1890,  1891. 

Wolif,  Lawrence,  M.D.,  Philadelphia,  1890. 
Wyman,  Walter,   A.M.,   M.D.,    Washington, 
1891. 

ASSISTANTS    TO    ASSOCIATE 
EDITORS. 

Baruch,  S.,  M.D.,  New  York,  1888. 
Beatty,  Franklin  T.,  M.D.,  Philadelphia,  1888. 
Brown,  Dillon,  M.D.,  New  York,  1888. 
Buechler,  A.  F.,  M.D.,  New  York,  1888. 
Burr,  Chas.  W.,  M.D.,  Philadelphia,  1891. 
Cohen,   Solomon    Solis,    M.D.,    Philadelphia, 

1889. 
Cooke,  B.  G.,  M.D.,  New  York,  1888. 
Coolidge,  Algernon,  Jr.,  M.D.,  Boston,  1890. 
Currier,  A.  F.,  M.D.,  New  York,  1888. 
Daniels.  F.  H.,  A.M.,  M.D.,  New  York,  1888. 
Deale,  Henry  B.,  M.D.,  Washington,  1890. 
Eshner,  A.  A.,  M.D.,  Philadelphia,  1891. 
Gould  George  M.,  M.D.,  Philadelphia,  1888. 
Grandin,  Egbert  H.,  M.D.,  New  York,  1888, 

1889. 
Greene,  E.  M.,  M  D.,  Boston,  1890. 
Guite'ras,  G.  M.,  M.D..  Washington,  1890. 
Hance,  L  H.,  A.M.,  M.D.,  New  York,  1891. 
Klingenschmidt,  C.  H.  A.,  M.D.,  Washington, 

1890. 
Martin,  Edward,  M.D.,  Philadelphia,  1891. 
McKee,  E.  S.,  M.D.,  Cincinnati,  1889, 1890, 1891. 
Myers,  P.  H.,  M.D.,  New  York,  1888. 
Packard,  F.  A.,  M.D..  Philadelphia,  1890. 
Pritchard.  W.  B.,  M.D.,  New  York,  1891. 
Sangree,  E.  B.,  A.M.,  M.D.,  Philadelphia,  1890. 
Sears,  G.  G.,  M.D.,  Boston,  1890. 
Shulz,  R.  C,  M.D.,  New  York,  1891. 
Souwers,  Geo.  F.,  M.D.,  Philadelphia,  1888. 
Taylor,  H.  L.,  M.D.,  Cincinnati,  1889,  1890. 
Vansant,  Eugene  L.,  M.D.,  Philadelphia,  1884 


(28) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 


ASSISTANTS    TO    ASSOCIATE 
EDITORS-(CONTINUED). 

Vickerv,  H.  F.,  M.D.,  Boston,  1890. 

Warner,  F.  M.,  M.D.,  New  York,  1888,  1889, 

1890 
Wells,  Brooks  H.,  M.D.,  New  York,  1888. 
W'eiult,  E.  C.  M.D.,  New  York,  1SS8. 
Wilder,  W.  H.,  M.D.,  Cincinnati,  1889. 
Wilson,  U.  Meigs,  M.D.,   Philadelphia,  1889. 
Wilson,  W.  R.,  .M.D.,  Philadelphia,  1891. 

CORRESPONDING    STAFF. 
EUROPE. 

Antal,  Dr.  Gesa  v.,  Puda-Pesth,  Hungary. 

Baginsky,  Dr.  A.,  Berlin  Germany. 

Baratoux,  Dr.  J.,  Paris,  France. 

Barker,  Mr.  A.  K.  J.,  London,  England. 

Barnes,  Dr.  Kaneourt,  London,  England. 

Bayer,  Dr.  Carl,  Prague,  Austria. 

Bouchut,  Dr.  E.,  Paris,  France. 

Bourneville,  Dr.  A.,  Paris,  France. 

Bramwell,  Dr.  Byron,  Edinburgh,  Scotland. 

Carter,  Mr.  William,  Liverpool,  England. 

Caspari,  Dr.  G.  A.,  Moscow,  Russia. 

Chiralt  v  Selma,  Dr.  V.,  Seville,  Spain. 

Cordes,  Dr.  A.,  Geneva,  Switzerland. 

D'Estrees,  Dr.  Debout,  Contrexeville,  France. 

Diakonoä.  Dr.  P.  .1.,  Moscow,  Russia. 

Dobrashian,  Dr.  G.  S.,  Constantinople,  Tur- 
key. 

Dole'ris.  Dr.  L.,  Paris,France. 

Doutrelepont,  Prof.,  Bonn,  Germany. 

Devon,  Dr.  II..  Lvons,  France. 

Drzewiecki,  Dr.  J^os.,  Waisaw,  Poland. 

Dubois-Reyniond,  I'rof.,  Berlin,  Germany. 

Ducrey,  Dr.  A..  Naples,  Italy. 

Dujardin-Beaumetz,  Dr.,  Paris,  France. 

Duke,  Dr.  Alexander,  Dublin,  Ireland. 

Eklund,  Dr.  F.,  Stockholm,  Sweden. 

Fokker,  Dr.  A.  P.,  Groningen,  Holland. 

Fort.  Dr.  J.  A.,  Paris,  France. 

Fournier.  Dr.  Henri.  Paris,  France. 

Franks,  Dr.  Kendal,  Dublin,  Ireland. 

Fremv,  Dr.  H.,  Nice,  France. 

Fry,  t>r.  George,  Dublin,  Ireland 

Go'lowina,  Dr.  A.,  Varna,  Bulgaria. 

Gouguenheim,  Dr.  A.,  Paris,  France. 

Haig,  Dr.  A.,  London,  England. 

Ramon,  Mr.  A.,  Paris,  France. 

Harley,  .Mr.  V.,  London,  England. 

Harley,  Mr.  H.  R.,  Nottingham,  England. 

Harley,  Prof.  Geo.,  London,  England. 

Harpe,  Dr.  de  la,  Lausanne,  Switzerland. 

Hartmann,  Prof.  Arthur,  Berlin,  Germany. 

Heitzmann.  Dr.  J.,  Vienna,  Austria. 

Helferich,  Prof..  Greifswald,  Germany. 

Hcwetson.  Dr.  Bendelack,  Leeds,  England. 

Hoff,  Dr.  E.  M.,  Copenhagen,  Denmark. 

Humphreys,  Dr.  F.  Rowland,  London,  Eng- 
land. 

lUingworth.  Dr.  C.  K.,  Accrington,  England. 

Jones,  Dr.  D.  M.  de  Silva,  Lisbon,  Portugal. 

Knott,  Dr.  .1.  F.,  Dublin,  Ireland. 

Krause,  Dr.  H.,  Berlin,  (Jcrmany. 

Landolt,  Dr.  E.,  Paris,  France. 

Levison,  Dr.  J.,  Copenhagen,  Denmark. 

Lutaud,  Dr.  A.,  Paris,  France. 

Mackay,  Dr.  W.  A.,  Huclva,  Spain. 

Mackowen.  Dr.  T.  C,  (Japri,  Italy. 

Manche',  Dr.  L.,  Valetta,  Malta. 

Massei.  Prof.  F.,  N;iplcs,  Italy. 

Mendez,  Prof.  R.,  Barcelona,  Spain. 
'Meyer,  Dr.  E..  Naj.hs,  Italy. 

Meyer.  Prof.  W,,  (,'oj)enhagen.  Denmark. 

Mono«.  Di'.  (Jharles.  Paris.  France. 

Montefu.<*co,  Prof.  A.,  Naples,  Italy. 

More-Madden,  Prof.  Thomas,  Dublin,  Ireland. 

Morel,  Dr.  J.,  Ghent,  Belgium. 

Mygind,  Dr.  Ilolgci-,  Copenhagen,  Denmark. 

Mynlielf.  i)r.  A..  Breukelcn,  Holland. 

Napier,  Dr.  A.  D.  Leith.  London,  England. 

Nicolich,  Dr..  Trieste,  Austria. 

OI)erIänder,  Dr.,  Dresden,  Germany. 

01>er»teincr,  Prof.,  Vienna  Austria. 

Pampouki»,  Dr.,  Athens,  Greece. 

Pannoni,  Dr.,  Naples,  Italy. 

Parker,  Mr.  Riishton.  Liverpool,  England. 

Pel,  Prof.  P.  K..  Amsterdam,  Holland. 

Pippinhkjold.  Dr..  Uclsingfois.  Finland. 

Pulido,  I^rof.  Angel,  Madrid,  Spain. 


Röna,  Dr.  S.,  Buda-Pesth,  Hungary. 

Rosenbusch,  Dr.  L.,  Lvov.  Galicia. 

Rossbach,  Prof.  M.  F.,  Jena,  Germany. 

St.  Germain,  Dr.  de,  Paris,  France. 

Sänger,  Prof.  INI..  Leipzig,  Germany. 

Santa,  Dr.  P.  de  Pietra,  Paris,  France. 

Schiffers,  Prof.,  Liege,  Belgium. 

Schmiegelow,  Prof.  JE.,  Copenhagen,  Den- 
mark. 

Scott,  Dr.  G.  M.,  Moscovv,  Russia. 

Simon,  Dr.  Jules,  Paris,  France. 

SoUier,  Dr.  P.,  Paris,  France. 

Solovvieff,  Dr.  A.  N.,  Lipetz,  Russia. 

Sota,  Prof.  R.  de  la,  Seville,  Spain. 

Sprimont,  Dr.,  Moscow,  Russia. 

Stockvis,  Prof.  B.  .J.,  Amsterdam,  Holland. 

Szadek,  Dr.  Carl,  Kiew,  Russia. 

Tait,  Mr.  Lawson,  Birmingham,  England. 

Thiriar,  Dr..  Brussels,  Belgium. 

Trifiletti,  Dr.,  Naples,  Italy. 

Tuke,  Dr.  D.  Hack,  London,  England. 

Uhik,  Dr.  Axel,  Copenhagen,  Denmark. 

Unverriclit,  Prof.,  Jena,  Germany. 

Van  der  Mey,  Prof.  G.  H.,  Amsterdam,  Hol- 
land. 

Van  Leent,  Dr.  F.,  Amsterdam,  Holland. 

Van  Millingen,  Prof.  E.,  Constantinople,  Tur- 
key. 

Van  Rijnberk,  Dr.,  Amsterdam,  Holland. 

Wilson,  Dr.  George,  Leamington,  England. 

W^olienden,  Dr.  Norris,  London,  England. 

Zweifel,  Prof.,  Leipzig,  Germany. 

AMERICA     AND     WEST     INDIES. 

Bittencourt,  Dr.  J.  C,  Rio  Janeiro,  Brazil. 
Cooper,  Dr.  Austin  N.,  Buenos  Ayres,  Argen- 
tine Republic. 
Dagnino,  Prf)f.  Manuel,  Caracas,  Venezuela. 
Desvernine,  Dr.  C.  M.,  Havana,  Cuba. 
Fernandez,  Dr.  ,1.  L.,  Havana,  Cul>a. 
Finlay,  Dr.  Charles,  Havana,  Cuba. 
Fontecha,  Prof.  R.,  Teguci.galpa,  Honduras. 
Harvey,  Dr.  Eldon,  Hamilton,  Bermuda. 
Herdocia,  Dr.  E.  Leon,  Nicaragua. 
Levi,  Dr.  Joseph,  Colon,  U.  S.  Columbia. 
Mello.  Dr.  Vierra  de,  Rio  .laneiro,  Brazil. 
Moir,  Dr.  J.  W.,  Belize,  British  Honduras. 
Moncorvo,  Prof.,  Rio  Janeiro,  Brazil. 
Pia,  Dr.  E.  F..  Havana,  Cuba. 
Rake,  Dr.  Beaven,  Trinidad. 
Rincon.  Dr.  F.,  Maracaibo,  Venezuela. 
Semeleder,  Dr.  F.,  Mexico,  Mexico, 
Soriano,  Dr.  M.  S.,  Mexico,  Mexico. 
Strachan,  Dr.  Henry,  Kingston,  Jamaica. 

OCEANICA,     AFRICA,     AND     ASIA. 

Baelz,  Prof.  R.,  Tokyo,  Japan. 
Barrett,  Dr.  Jas.  W.,  Melbourne,  Australia, 
Branfoot,  Dr.  A.  M.,  Madras,  India. 
Carageorgiades,  Dr.  J.  G^Limassol,  Cyprus. 
Cochran,  Dr.  Joseph  P.,  Oroomiah,  Persia. 
Coltman,  Dr.  Robert,  Jr.,  Che-foo,  China. 
Condict,  Dr.  Alice  W.,  Bombay,  India. 
Creece,  Dr.  John  M.,  Sydney,  Australia. 
Dalzell,  Dr.  J.,  Umsiga,  Natal. 
Diamantopulos,  Dr.  Geo.,  Smyrna,  Turkey. 
Drake-Biockman,  Dr.,  Madras,  India. 
Fitzgerald,  Mr.  T.  N.,  Melbourne,  Australia. 
Foreman,  Dr.  L.,  Sydney,  Australia. 
Gaidzagian,  Dr.  Oban,  Adana,  Asia  Minor. 
Grant,  Dr.  David,  Melbourne,  Australia. 
Johnson,  Dr.  R.,  Dera  Ishmail  Khan,  Bcloo- 

chistan. 
Kiniura,  Prof.  J.  K.,  Tokyo,  Japan. 
Knaggs,  Dr.  S.,  Sydney,  Australia. 
Manasseh,  Dr.  IJeshara  I.,  Brummana,  Turkey 

in  Asia. 
McCandless,  Dr.  H.  H.  Hainan,  China. 
Molonev,  Dr.  J.,  Melbourne,  Australia. 
Neve,  I^r.  Arthur,  Bombay,  India. 
Perez,  Dr.  George  V.,  Puerto  Orotava,  Tene- 

riife. 
Reid,  Dr.  John,  Molbonrnc,  Australia. 
Robertson,  l)i-.  W.  S.,  I^)rtSaid,  Egypt. 
Rouvier,  Prof.  Jules,  Beyrouth,  Syria. 
S<'ranton,  Di-.  William  B",  Seoul,  Corea. 
Sinclair,  Dr.  II.,  Sydney,  Australia. 
Thompson,  Di-.  .laines  B  ,  Pctchaburee,  Siam. 
Wheeler,  Dr.  P.  d'K.,  Jerusalem,  I'alestine. 
Whitney,  Dr.  H.  T.,  Foochow,  (_'htna. 
Whitney,  Dr.  W.  Norton,  Tokyo,  Japan. 


(29) 


Medical  Publications  of  F.  A.  Davis,  Philadelphia. 
MANNJEY 

Lectures  on  Nervous  Diseases. 

From  the  Stand-Potnt  of  Cerebral   and   Spinal  Localization,  and 

THE  Later  Methods  Employed  in  the  Diagnosis  and 

Treatment  of  these  Affections. 

By  Ambrose  L.  Ranney,  A.M.,  M.D.,  Professor  of  the  Anatom^y  and 
Physiolooy  of  the  Nervous  System  in  the  New  York  Post-Gradiiate 
Medical  School  and  Hospital ;  Professor  of  Nervous  and  Mental  Diseases 
in  the  Medical  Department  of  the  University  of  Vermont,  etc. ;  Author 
of  "The  Applied  Anatom}--  of  the  Nervous  Sj^stem,"  "  Practical  Medical 
Anatomy,"  etc.,  etc. 

>^  It  is  now  generally  conceded  that  the  nervous  system  controls  all 
of  the  physical  functions  to  a  greater  or  less  extent,  and  also  that  most 
of  the  symptoms  encountered  at  the  bedside  can  be  explained  and 
interpreted  from  the  stand-point  of  nervous  physiolog3\ 

Profusely  illustrated  with  original  diagrams  and  sketches  in  color 
by  the  author,  cai'efuUy  selected  wood-engravings,  and  reproduced  photo- 
graphs of  typical  cases.    One  handsome  royal  octavo  volume  of  780  pages. 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Cloth,  $5  50 ;  Sheep,  $S.50 ;  Half-Russia,  $7.00. 
Canada  (duty  paid),  Cloth,  $5.05 ;  Sheep,  $7.15  ;  Half-Russia,  $7.70. 
Great  Britain,  Cloth,  32s. ;  Sheep,  37s.  6d. ;  Half-Russia,  ^Os.  France, 
Cloth,  34  fr.  70;  Sheep,  40  fr.  45;  Half-Russia,  43  fr.  30. 


We  are  glad  to  note  that  Dr.  Ranney  has 
published  in  book  form  his  admirable  lectures 
on  nervous  diseases.  His  book  contains  over 
seven  hundred  large  pnges,  and  is  profusely 
illnstrated  with  original  diagrams  and  sketches 
in  colors,  and  with  many  carefully  selected 
wood-cuts  and  reproduced  photographs  of 
typical  cases.  A  large  amount  of  valuable 
information,  not  a  little  of  which  has  but 
recently  appeared  in  medical  literature,  is  pre- 


sented in  compact  form,  and  thus  made  easily 
accessible.  In  our  opinion,  Dr.  Ranney' s  boot 
ought  to  meet  with  a  cordial  reception  at  the 
hands  of  the  medical  profession,  for,  even 
though  the  author's  views  may  be  sometimes 
open  to  question,  it  cannot  be  disputed  that 
his  work  bears  evidence  of  scientific  method 
and  honest  opinion. — American  Journal  of 
Insanity. 


ST-A_i>q:TO]sr*s 


Practical  and  Scientific  Physiognomy; 


I&Eo^xT'    to    IE^e:a-ci    Fa.c;e;s. 

By  Mary  Olmsted  Stanton.  Copiously  illustrated.  Two  large 
Octavo  A'olumes. 

The  author,  Mrs.  Mary  0.  Stanton,  has  given  over  twenty  years  to 
the  preparation  of  this  work.  Her  style  is  easy,  and,  b}^  her  happy 
method  of  illustration  of  every  point,  the  book  reads  like  a  novel  and 
memorizes  itself.  To  physicians  the  diagnostic  information  conveyed  is 
invaluable.  To  the  general  reader  each  page  opens  a  new  train  of  ideas. 
(This  book  has  no  reference  whatever  to  phrenology.") 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Cloth,  $9.00 ;  Sheep,  $11.00 ;  Half-Russia,  $13.00. 
Canada  (duty  paid),  Cloth,  $10.00;  Sheep,  $12.10;  Half-Russia, 
$14.30.  Great  Britain,  Cloth,  56s. ;  Sheep,  68s. ;  Half-Russia,  SOs. 
France,  Cloth,  30  fr.  30 ;  Sheep,  36  fr.  40 ;  Half-Russia,  43  fr.  30. 

(30) 


Medical  FuhUcations  of  F.  A.  Davis,  Philadelphia. 
SAJO  US 

Lectures  on  the  Diseases  of  the  Nose 
and  Throat. 

Delivered  at  the  Jefferson  Medical  College,  Philadelphia. 

By  Charles  E.  Sajous,  ]\[.D.  Formerly  Lecturer  on  Rliiuology  and 
Laryngology  in  JeHerson  Medical  College ;  Vice-President  of  the 
American  Laryngological  Association  ;  Officer  of  tlie  Academy  of 
France  and  of  Public  Instruction  of  Venezuela  ;  Corresponding  Member 
of  the  Royal  Society  of  Belgium,  of  the  Medical  Society  of  Warsaw 
(Poland),  and  of  tlie  Society  of  Hygiene  of  France;  Member  of  the 
Americnn  Philosophical  Society,  etc.,  etc. 

^^^ Since  the  publisher  brought  this  valuable  work  before  the  j)ro- 
fession,  it  hau  become:  1st,  the  text-book  of  a  large  nuvtber  of  colleges; 
2d,  the  reference  book  of  the  Ü.  S.  Army,  Navy,  and  the  Marine  Service; 
and.  3d.  an  important  and  valued  addition  to  the  libraries  of  over  10,000 
physicians. 

This  book  has  not  only  the  inherent  merit  of  presenting  a  clear 
expose  of  the  subject,  but  it  is  -nritten  with  a  view  to  enable  the  general 
practitioner  to  treat  his  cases  himself.  To  facilitate  diagnosis,  colored 
jylates  are  introduced,  showing  the  appearance  of  the  different  parts  in 
the  diseased  state  as  they  appear  in  nature  by  artificial  light.  No  error 
can  thus  be  made,  as  each  affection  of  the  nose  and  throat  has  its  repre- 
sentative in  the  100  chromo-lithographs  presented.  In  the  matter  of 
treatment,  the  indications  are  so  complete  that  even  the  slightest  pro- 
cedures, folding  of  cottou  for  the  forceps,  the  use  of  the  probe,  etc.,  are 
clearly  explained. 

Illustrated  with  100  chromo-lithographs,  from  oil  paintings  by  the 
author,  and  93  engravings  on  wood.    One  handsome  royal  octavo  volume. 

SOLD  ONLY  BY  SUBSCRIPTION,  OR  SENT  DIRECT  ON  RECEIPT  OF  PRICE, 
SHIPPING  EXPENSES  PREPAID. 

Price,  in  United  States,  Clotli,  Royal  Octavo,  $4 .00 ;  Half-Russia,  Royal 
Octavo,  $5.00.  Canada  (duty  paid).  Cloth,  $4.40 ;  Half-Russia,  $5.50. 
Great  Britain,  Cloth,  22s.  6d. ;  Sheep  or  Half-Russia,  28s.  France, 
Cloth,  24  fr.  60 ;  Half- Russia,  30  fr.  30. 

It  is  intended  to  furnish  the  fteneral  practi-  I  to  him  were  they  seen  in  the  living  subject. 

tloner  not  only  with  a  guide  for  the  treatment  As  a  guide  to  the  treatment  of  the  nose  and 

of  diseases  of  the  nose  and  tiiroat,  but  also  to  throat,  we  can  cordially  recommend  this  work, 

place  before  him  a  representation  of  the  nor-  —Boston  Medical  and  Surgical  Journal. 

mal  and  diseased  parts  as  they  would  appear  1 1 


THE  CHINESE:  Their  Present  and  Future;  Medical,  Political,  and  Social. 

By  ROBERT  COLTMAN,  Jr.,  M.D  ,  Surgeon  in  Charge  of  the  Presbyterian 
Hospital  and  Dispensary  at  Teng  Chow  Fn;  Consulting  Pliysician  of  the  American 
Southern  Baptist  Mission  Society;  Examiner  in  Surgery  and  Diseases  of  the  Eye 
for  the  Shantung  Medical  Class;  Consulting  Pliysician  to  the  English  Baptist 
Missions,  etc.  Illustrated  with  about  Sixteen  Fine  Engravings  from  photographs 
of  persons,  places,  and  objects  characteristic  of  China.  In  one  Octavo  volume  of 
about  2150  pages.     Ready  About  Deckmber  1,  1891. 

The  author  has  spent  many  years  among  the  Chinese;  lived  with  them 
in  their  dwellings;  thoroughlt  learned  the  language;  has  become  conversant 
with  all  their  strange  and  odd  characteristics  to  a  greater  extent  than  almost  any 
other  American.  He  has  been  a  physician  to  all  classes  of  this  wonderful  people, 
and  the  opportunities  t))us  afforded  for  a  clear  insight  into  the  inner  life  of  the 
Chinese,  their  virtues  and  vices,  pf)litifal,  social,  and  sanitary  condition,  probale 
destiny,  and  their  present  important  position  in  the  world  today,  have  been  ably 
and  wisely  used  by  Dr.  Collman. 

(81) 


Medical  Publications  of  F.  Ä.  Davis,  Philadelphia. 

' — — — — '. • ' 

JSTearly  Ready,     Will  he  Issued  about  October  1,  1891, 


Age  of  the  Domestic  Animals. 

Being  a   Complete   Treatise  on   the   Dentition   of   the   Horse,  Ox, 

Sheep,  Hog,  and  Dog,  and  on  the  Various  Other  Means 

of  Telling  the  Age  of  these  Animals. 

By  R.USH  Shippen  Huidekoper,  M.D.,  Veterinarinn,  Alfort,  France. 
Professov  of  Sanitary  Medicine  and  Vetei-inarj^  Jnrisprndence  in-  the 
American  Veterinary  College,  New  York ;  Lieutenant-Colonel  and  Sur- 
geon-in-Chief  National  Guard  of  Pennsylvania;  Fellow  of  the  College 
of  Physicians,  Philadelphia;  Honorary  Fellow  of  the  Royal  College 
Veterinary  Surgeons,  London  ;  Late  Dean  of  the  Veterinary  Department 
University  of  Pennsylvania,  etc.,  etc. 

Complete  in  one  handsome  Royal  Octavo  volume,  with  about  160 
Illustrations.  This  is  one  of  the  most  important  works  on  the  domestic 
animals  published  in  recent  3'ears. 


Heady  Very  Shortly, 


A,  B,  C  of  the  Swedish  System  of 
Educational  Gymnastics. 

A  Practical  Hand-Book  for  School-Teaghers  and  the  Home. 

Bj'  Hartvig  Nissen,  Instructor  of  Physical  Training  in  the  Public 
Schools  of  Boston,  Mass.;  Instructor  of  Swedish  and  German  G3'mnas- 
tics  at  Harvard  University's  Summer  School,  1891;  Author  of  "A 
Manual  on  Swedish  Movement  and  Massage  Treatment,"  etc.,  etc. 

Complete  in  one  neat  12mo  volume,  bound  in  extra  flexible  cloth 
and  appropriately  illustrated  with  77  excellent  engravings  aptly  eluci- 
dating the  text. 


Lectures  on  Auto-Intoxication. 

By  Prof.  Bouchard,  Paris.  Translated  from  the  French,  with  an 
Original  Appendix  by  the  author.  By  Thomas  Oliver,  M.D.,  Professor 
of  Physiology  in  Universitj'^  of  Durham,  England.     In  Press. 


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